Healthcare Provider Details

I. General information

NPI: 1891046884
Provider Name (Legal Business Name): HEALTHCARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOURLAND RD STE 160
KELLER TX
76248-3592
US

IV. Provider business mailing address

100 BOURLAND RD STE 160
KELLER TX
76248-3592
US

V. Phone/Fax

Practice location:
  • Phone: 817-337-9998
  • Fax: 817-337-9991
Mailing address:
  • Phone: 817-337-9998
  • Fax: 817-337-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28254
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JACKY TRUONG
Title or Position: PIC
Credential:
Phone: 817-337-9998