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NPI Code Detail

MEDICARE: DALLAS COUNTY MENTAL HEALTH & MENTAL RETARDATION CENTER

MEDICARE: DALLAS COUNTY MENTAL HEALTH & MENTAL RETARDATION CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0002XClinic Pharmacy29414TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12147305OTHERPK

General Provider Information

NPI Number : 1093114134
Entity Type Code : Organization
Provider Name (Legal Business Name) : DALLAS COUNTY MENTAL HEALTH & MENTAL RETARDATION CENTER
Provider Business Mailing Address
First Line : 3242 REMOND DR
Second Line : ATTN: PHARMACY
City : DALLAS
State : TX
Zip : 75211
Country : US
Telephone Number : 214-743-6180
Fax Number : 469-200-1956
Provider Business Practice Location Address
First Line : 1020 S CARRIER PKWY
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75051-1527
Country : US
Telephone Number : 214-330-2424
Fax Number : 214-330-2422
Authorized Official
Title or Position : CHIEF PHARMACY OFFICER
Name : MIN SEO CHEON KIM
Credential :
Telephone Number : 214-743-6180
Provider Enumeration Date : 08/14/2014
Last Update Date : 12/02/2025

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