Provider Demographics
NPI:1740507599
Name:MD PHARMACUETICALS LLC
Entity type:Organization
Organization Name:MD PHARMACUETICALS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-822-3615
Mailing Address - Street 1:502 S OLD ORCHARD LN
Mailing Address - Street 2:SUITE 128
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4370
Mailing Address - Country:US
Mailing Address - Phone:972-906-0067
Mailing Address - Fax:972-906-9084
Practice Address - Street 1:204 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ITALY
Practice Address - State:TX
Practice Address - Zip Code:76651-3517
Practice Address - Country:US
Practice Address - Phone:972-483-7667
Practice Address - Fax:972-483-7670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MD PHARMACUETICALS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-03
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX268713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26871OtherTEXAS STATE BOARD OF PHARMACY