Provider Demographics
NPI:1780727404
Name:UNIVERSITY OF TEXAS AT ARLINGTON
Entity type:Organization
Organization Name:UNIVERSITY OF TEXAS AT ARLINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARTENHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-272-2770
Mailing Address - Street 1:605 S WEST ST
Mailing Address - Street 2:BOX 19329
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76019-0001
Mailing Address - Country:US
Mailing Address - Phone:817-272-2770
Mailing Address - Fax:817-272-7192
Practice Address - Street 1:605 S WEST ST
Practice Address - Street 2:BOX 19329
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76019-0001
Practice Address - Country:US
Practice Address - Phone:817-272-2770
Practice Address - Fax:817-272-7192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX066653336C0003X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX06665OtherPHARMACY LICENSE
TX4551936OtherNABP,NCPDP NUMBER