Provider Demographics
NPI:1649846494
Name:CRESTMARK PHARMACY SERVICES OF TEXAS LLC
Entity type:Organization
Organization Name:CRESTMARK PHARMACY SERVICES OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MATHES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:850-381-1433
Mailing Address - Street 1:433 N MACARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3767
Mailing Address - Country:US
Mailing Address - Phone:850-381-1433
Mailing Address - Fax:850-872-1321
Practice Address - Street 1:220 ELLA ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5094
Practice Address - Country:US
Practice Address - Phone:346-273-0002
Practice Address - Fax:866-393-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy