Healthcare Provider Details

I. General information

NPI: 1659316792
Provider Name (Legal Business Name): MED SHOP PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 US HIGHWAY 271 N
GILMER TX
75644-5580
US

IV. Provider business mailing address

825 US HIGHWAY 271 N
GILMER TX
75644-5580
US

V. Phone/Fax

Practice location:
  • Phone: 903-680-2600
  • Fax: 903-680-2605
Mailing address:
  • Phone: 903-680-2600
  • Fax: 903-680-2605

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 Number23042
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

VIII. Authorized Official

Name: MR. PATRICK WAYNE POWERS
Title or Position: PHARMACIST
Credential: RPH
Phone: 903-680-2600