Provider Demographics
NPI:1972668309
Name:DALLAS PHARMACEUTICAL CORP
Entity Type:Organization
Organization Name:DALLAS PHARMACEUTICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HEDAYAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SAADAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-216-7000
Mailing Address - Street 1:910 N GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2409
Mailing Address - Country:US
Mailing Address - Phone:972-216-7000
Mailing Address - Fax:
Practice Address - Street 1:910 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2409
Practice Address - Country:US
Practice Address - Phone:972-216-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145499Medicaid
4532784OtherOTHER ID NUMBER-COMMERCIAL NUMBER