Provider Demographics
NPI:1205579604
Name:MINDFUL PHARMACY LLC
Entity type:Organization
Organization Name:MINDFUL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:CATHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-265-1818
Mailing Address - Street 1:9101 N CENTRAL EXPY STE 160
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5951
Mailing Address - Country:US
Mailing Address - Phone:214-265-1818
Mailing Address - Fax:
Practice Address - Street 1:2701 OSLER DR STE 1
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8351
Practice Address - Country:US
Practice Address - Phone:214-265-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy