Provider Demographics
NPI:1205331311
Name:SRR HEALTHCARE INC
Entity type:Organization
Organization Name:SRR HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNERR
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NDEREVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-969-0090
Mailing Address - Street 1:1210 E PARKER RD
Mailing Address - Street 2:STE - 120
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5334
Mailing Address - Country:US
Mailing Address - Phone:469-969-0090
Mailing Address - Fax:469-969-0095
Practice Address - Street 1:1210 E PARKER RD STE 120
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5376
Practice Address - Country:US
Practice Address - Phone:469-969-0090
Practice Address - Fax:469-969-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX319373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176783OtherPK