Provider Demographics
NPI:1649304189
Name:MD PHARMACY
Entity type:Organization
Organization Name:MD PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-829-4611
Mailing Address - Street 1:11540 EAGLE DR
Mailing Address - Street 2:STE A
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-7653
Mailing Address - Country:US
Mailing Address - Phone:281-576-0106
Mailing Address - Fax:281-576-5511
Practice Address - Street 1:11540 EAGLE DR
Practice Address - Street 2:STE A
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77523-7653
Practice Address - Country:US
Practice Address - Phone:281-576-0106
Practice Address - Fax:281-576-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100018OtherPK
TX145776Medicaid