Provider Demographics
NPI:1396747291
Name:JIM CALDWELL
Entity type:Organization
Organization Name:JIM CALDWELL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPH
Authorized Official - Phone:325-625-2178
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834-0817
Mailing Address - Country:US
Mailing Address - Phone:325-625-2178
Mailing Address - Fax:325-625-3056
Practice Address - Street 1:312 S COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-4214
Practice Address - Country:US
Practice Address - Phone:325-625-9448
Practice Address - Fax:325-625-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
3336C0003X, 3336L0003X, 3336S0011X
TX00004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010673401Medicaid
TX017073001Medicaid
TX140971Medicaid
TX140971Medicaid