Provider Demographics
NPI:1457496473
Name:WHITE CROSS RX LLC
Entity Type:Organization
Organization Name:WHITE CROSS RX LLC
Other - Org Name:WHITE CROSS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-215-9072
Mailing Address - Street 1:1303 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 128
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5609
Mailing Address - Country:US
Mailing Address - Phone:210-227-7207
Mailing Address - Fax:210-227-4763
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-227-7207
Practice Address - Fax:210-227-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10309333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142486Medicaid
TX0758300001Medicare ID - Type Unspecified