Basic Information
Provider Information | |||||||||
NPI: | 1730359712 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PHARMED L.P. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FAMILY CARE PHARMACY #4 | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 260329 | ||||||||
Address2: |   | ||||||||
City: | PLANO | ||||||||
State: | TX | ||||||||
PostalCode: | 750260329 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9725966690 | ||||||||
FaxNumber: | 9725966696 | ||||||||
Practice Location | |||||||||
Address1: | 1200 WOODHAVEN BLVD | ||||||||
Address2: |   | ||||||||
City: | FORT WORTH | ||||||||
State: | TX | ||||||||
PostalCode: | 761122376 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8175070162 | ||||||||
FaxNumber: | 8175070163 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/06/2008 | ||||||||
LastUpdateDate: | 09/17/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DAVANI | ||||||||
AuthorizedOfficialFirstName: | SAEID | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
AuthorizedOfficialTelephone: | 9725966690 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | R.PH. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 22345 | TX | N |   | Suppliers | Pharmacy |   | 332B00000X | 22345 | TX | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
ID Information
ID | Type | State | Issuer | Description | 145236 | 05 | TX |   | MEDICAID | 1396750931 | 01 | TX | NPI | OTHER | 4525854 | 01 | TX | NCPDP | OTHER | 193945601 | 01 | TX | TPI | OTHER |