Provider Demographics
NPI:1013903764
Name:A & P PHARMACY, INC
Entity type:Organization
Organization Name:A & P PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PRAVALLIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-431-3110
Mailing Address - Street 1:207 E BYRON NELSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262
Mailing Address - Country:US
Mailing Address - Phone:817-431-3110
Mailing Address - Fax:817-491-1358
Practice Address - Street 1:207 E BYRON NELSON BLVD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:817-431-3110
Practice Address - Fax:817-491-1358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A & P PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-27
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19859332B00000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144931Medicaid
TX148927Medicaid
TX067832801Medicaid