Provider Demographics
NPI:1801026638
Name:TXEX MED LLC
Entity type:Organization
Organization Name:TXEX MED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:830-868-7185
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78636-0433
Mailing Address - Country:US
Mailing Address - Phone:830-868-7185
Mailing Address - Fax:830-868-7183
Practice Address - Street 1:405 HWY 281 SOUTH
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TX
Practice Address - Zip Code:78636
Practice Address - Country:US
Practice Address - Phone:830-868-7185
Practice Address - Fax:830-868-7183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28451333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140036OtherPK