Provider Demographics
NPI:1356356950
Name:INDEPENDENT PHARMACY ASSOCIATES LLC
Entity type:Organization
Organization Name:INDEPENDENT PHARMACY ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-864-1110
Mailing Address - Street 1:3641 BROADWAY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1608
Mailing Address - Country:US
Mailing Address - Phone:972-864-1110
Mailing Address - Fax:972-864-1115
Practice Address - Street 1:3641 BROADWAY BLVD STE 100
Practice Address - Street 2:SUITE 100
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1676
Practice Address - Country:US
Practice Address - Phone:972-864-1110
Practice Address - Fax:972-864-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 333600000X
TX226963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098901OtherPK
TX149326Medicaid
2098901OtherPK