Healthcare Provider Details

I. General information

NPI: 1144544685
Provider Name (Legal Business Name): KINDLE MAYBERRY INVESTMENT GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 HWY 175 STE 800
CRANDALL TX
75114
US

IV. Provider business mailing address

PO BOX 100
CRANDALL TX
75114-0100
US

V. Phone/Fax

Practice location:
  • Phone: 972-427-6442
  • Fax: 972-427-6470
Mailing address:
  • Phone: 903-972-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number26860
License Number StateTX

VIII. Authorized Official

Name: GARY MAYBERRY
Title or Position: PHARMACIST
Credential:
Phone: 972-427-6442