Provider Demographics
NPI:1669400081
Name:ABELDTS GASLIGHT PHARMACY INC
Entity type:Organization
Organization Name:ABELDTS GASLIGHT PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BUFORD
Authorized Official - Middle Name:T
Authorized Official - Last Name:ABELDT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:936-639-2346
Mailing Address - Street 1:200 GASLIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:936-639-0612
Mailing Address - Fax:936-639-2322
Practice Address - Street 1:200 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-639-0612
Practice Address - Fax:936-639-2322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABELDTS GASLIGHT PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-28
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0508820002Medicare NSC