Healthcare Provider Details

I. General information

NPI: 1023410024
Provider Name (Legal Business Name): DALLAS COUNTY MENTAL HEALTH & MENTAL RETARDATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16160 MIDWAY RD STE 200 ATTN: PHARMACY
ADDISON TX
75001-4202
US

IV. Provider business mailing address

16160 MIDWAY RD STE 200 ATTN: PHARMACY
ADDISON TX
75001-4202
US

V. Phone/Fax

Practice location:
  • Phone: 972-331-6370
  • Fax: 214-330-2491
Mailing address:
  • Phone: 972-331-6370
  • Fax: 214-330-2491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number29518
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MORDECHAI EDERY
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 214-743-6180