Healthcare Provider Details

I. General information

NPI: 1497271308
Provider Name (Legal Business Name): CALVARY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 N HIGHWAY 67 STE 150
CEDAR HILL TX
75104-2100
US

IV. Provider business mailing address

PO BOX 542393
GRAND PRAIRIE TX
75054-2393
US

V. Phone/Fax

Practice location:
  • Phone: 972-637-4324
  • Fax: 972-637-3425
Mailing address:
  • Phone: 816-797-3424
  • Fax: 972-637-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number31556
License Number StateTX

VIII. Authorized Official

Name: DR. WILKINSON O THOMAS
Title or Position: PHARMACY MANAGER
Credential: PHD,RPH
Phone: 972-637-4324