Healthcare Provider Details

I. General information

NPI: 1174782825
Provider Name (Legal Business Name): HEREFORD PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2008
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 S 25 MILE AVE
HEREFORD TX
79045
US

IV. Provider business mailing address

809 S 25 MILE AVE
HEREFORD TX
79045-4801
US

V. Phone/Fax

Practice location:
  • Phone: 806-364-3400
  • Fax: 806-364-3405
Mailing address:
  • Phone: 806-364-3400
  • Fax: 806-364-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6298500001
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number26063
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number26063
License Number StateTX

VIII. Authorized Official

Name: CHRISTINA MARIE MOORE
Title or Position: OWNER
Credential:
Phone: 806-995-3551