Provider Demographics
NPI:1477397628
Name:CEDAR PARK EXPRESS PHARMACY INC.
Entity type:Organization
Organization Name:CEDAR PARK EXPRESS PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WALID
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:JAMALEDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-215-2590
Mailing Address - Street 1:1841 S LAKELINE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4666
Mailing Address - Country:US
Mailing Address - Phone:512-215-2590
Mailing Address - Fax:
Practice Address - Street 1:1841 S LAKELINE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4666
Practice Address - Country:US
Practice Address - Phone:512-215-2590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-22
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy