Provider Demographics
NPI:1982717815
Name:ALSABROOK INC
Entity Type:Organization
Organization Name:ALSABROOK INC
Other - Org Name:RAY'S TOWN NORTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSABROOK
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:817-274-8221
Mailing Address - Street 1:975 N COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5781
Mailing Address - Country:US
Mailing Address - Phone:817-274-8221
Mailing Address - Fax:817-861-3497
Practice Address - Street 1:975 N COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5781
Practice Address - Country:US
Practice Address - Phone:817-274-8221
Practice Address - Fax:817-861-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX272183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143241Medicaid
2129954OtherPK