Provider Demographics
NPI:1134626278
Name:TANK CHESTERFIELD LLC
Entity type:Organization
Organization Name:TANK CHESTERFIELD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:HICKS
Authorized Official - Last Name:STEGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:214-395-2987
Mailing Address - Street 1:9139 VINTAGE OAKS CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4705
Mailing Address - Country:US
Mailing Address - Phone:214-395-2987
Mailing Address - Fax:
Practice Address - Street 1:102 N SHILOH RD STE 305
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6695
Practice Address - Country:US
Practice Address - Phone:972-272-0840
Practice Address - Fax:214-594-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31922333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy