Healthcare Provider Details

I. General information

NPI: 1679515977
Provider Name (Legal Business Name): TEXAS COMMUNITY PHARMACY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 TEASLEY LN STE 100
DENTON TX
76210-4651
US

IV. Provider business mailing address

4400 TEASLEY LN SUITE 100
DENTON TX
76210-4650
US

V. Phone/Fax

Practice location:
  • Phone: 940-382-1618
  • Fax: 940-898-1986
Mailing address:
  • Phone: 940-382-1618
  • Fax: 940-898-1986

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 Number21325
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KELLY SELBY
Title or Position: PRESIDENT/PIC
Credential: BS PHARMACY
Phone: 940-382-1618