Provider Demographics
NPI:1013096791
Name:AFHCPH 1 LP
Entity Type:Organization
Organization Name:AFHCPH 1 LP
Other - Org Name:PREMIER HEALTH CARE CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:OURSBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-771-3565
Mailing Address - Street 1:4833 50TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-3418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4833 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3418
Practice Address - Country:US
Practice Address - Phone:806-771-3565
Practice Address - Fax:806-771-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4543078OtherOTHER ID NUMBER-COMMERCIAL NUMBER