Healthcare Provider Details

I. General information

NPI: 1285629337
Provider Name (Legal Business Name): MC CRORY PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 DEW DR SUITE 100
EL PASO TX
79912-3909
US

IV. Provider business mailing address

6151 DEW DR SUITE 100
EL PASO TX
79912-3909
US

V. Phone/Fax

Practice location:
  • Phone: 915-581-9655
  • Fax: 915-587-6556
Mailing address:
  • Phone: 915-581-9655
  • Fax: 915-587-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number03322
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY EDWIN MCCRORY
Title or Position: PRESIDENT
Credential: RPH.
Phone: 915-581-9655