Provider Demographics
NPI:1740037555
Name:DIVINE HEALTH PHARMACY
Entity type:Organization
Organization Name:DIVINE HEALTH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:708-969-0102
Mailing Address - Street 1:6730 ATASCOCITA RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ATASCOCITA
Mailing Address - State:TX
Mailing Address - Zip Code:77346-1995
Mailing Address - Country:US
Mailing Address - Phone:281-318-7696
Mailing Address - Fax:
Practice Address - Street 1:6730 ATASCOCITA RD STE 114
Practice Address - Street 2:
Practice Address - City:ATASCOCITA
Practice Address - State:TX
Practice Address - Zip Code:77346-1995
Practice Address - Country:US
Practice Address - Phone:281-318-7696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy