Provider Demographics
NPI:1982778452
Name:MED CARE PHARMACY INC
Entity Type:Organization
Organization Name:MED CARE PHARMACY INC
Other - Org Name:MED CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREL
Authorized Official - Middle Name:
Authorized Official - Last Name:KERBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-645-5933
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:DAINGERFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75638-0715
Mailing Address - Country:US
Mailing Address - Phone:903-645-5933
Mailing Address - Fax:903-645-5934
Practice Address - Street 1:213 W SCURRY ST STE C
Practice Address - Street 2:
Practice Address - City:DAINGERFIELD
Practice Address - State:TX
Practice Address - Zip Code:75638-1661
Practice Address - Country:US
Practice Address - Phone:903-645-5933
Practice Address - Fax:903-645-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144587Medicaid
4599493OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1245590001Medicare NSC