Provider Demographics
NPI:1932586542
Name:PRESCRIPTION SHOP MARFA
Entity Type:Organization
Organization Name:PRESCRIPTION SHOP MARFA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:432-294-2498
Mailing Address - Street 1:PO BOX 1629
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79831-1629
Mailing Address - Country:US
Mailing Address - Phone:432-294-2498
Mailing Address - Fax:432-837-9114
Practice Address - Street 1:105 E. OAK ST
Practice Address - Street 2:
Practice Address - City:MARFA
Practice Address - State:TX
Practice Address - Zip Code:79843
Practice Address - Country:US
Practice Address - Phone:432-294-2498
Practice Address - Fax:432-837-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy