NPI age
20 years
Enumerated 2006-05-12
Across 5625 active pharmacy providers in Texas.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | C08409365 | MEDICARE EDI NO. |
| 01 (TX) | D08601893 | DMERC REG D EDI # |
| 05 (TX) | 140266 | |
| 05 (OK) | 100244580A | |
| 01 (TX) | 4511374 | NCPDP |
Multi-provider organization. 1 individual provider on file at this primary address.
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