Provider Demographics
NPI:1992378525
Name:DALLAS PRESCRIPTION SHOP, LLC
Entity Type:Organization
Organization Name:DALLAS PRESCRIPTION SHOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SHERRER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:770-505-0255
Mailing Address - Street 1:537 HARDEE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-4711
Mailing Address - Country:US
Mailing Address - Phone:770-505-0255
Mailing Address - Fax:770-505-2155
Practice Address - Street 1:537 HARDEE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-4711
Practice Address - Country:US
Practice Address - Phone:770-505-0255
Practice Address - Fax:770-505-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy