Provider Demographics
NPI:1255637229
Name:FAVOS INCORPORATED
Entity type:Organization
Organization Name:FAVOS INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINSEYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-348-1038
Mailing Address - Street 1:6053 MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2062
Mailing Address - Country:US
Mailing Address - Phone:214-494-6222
Mailing Address - Fax:214-494-6223
Practice Address - Street 1:6053 MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2062
Practice Address - Country:US
Practice Address - Phone:214-494-6222
Practice Address - Fax:214-494-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 3336M0003X, 333600000X
TX274173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5902780OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX6860320001Medicare NSC