Provider Demographics
NPI:1457427916
Name:ABC PHARMACY INC.
Entity Type:Organization
Organization Name:ABC PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CARLISLE
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-885-3121
Mailing Address - Street 1:107 GILMER ST N
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2675
Mailing Address - Country:US
Mailing Address - Phone:903-885-3121
Mailing Address - Fax:903-885-0096
Practice Address - Street 1:107 GILMER ST N
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2675
Practice Address - Country:US
Practice Address - Phone:903-885-3121
Practice Address - Fax:903-885-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20269183500000X
TX16923333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4532215OtherNABP
TX144394Medicaid