Healthcare Provider Details

I. General information

NPI: 1538273529
Provider Name (Legal Business Name): TIMBERLAND MEDICINE CHEST 136 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S TIMBERLAND DR
LUFKIN TX
75901-4879
US

IV. Provider business mailing address

PO BOX 6397
TYLER TX
75711-6397
US

V. Phone/Fax

Practice location:
  • Phone: 936-632-2260
  • Fax: 903-885-1024
Mailing address:
  • Phone: 903-885-0821
  • Fax: 903-885-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28849
License Number StateTX

VIII. Authorized Official

Name: CHAD MICHEL
Title or Position: CEO
Credential:
Phone: 903-885-0821