Healthcare Provider Details

I. General information

NPI: 1376672204
Provider Name (Legal Business Name): CITY DRUG STORE OF NOCONA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 CLAY STREET
NOCONA TX
76255-0458
US

IV. Provider business mailing address

PO BOX 458 216 CLAY STREET
NOCONA TX
76255-0458
US

V. Phone/Fax

Practice location:
  • Phone: 940-825-3226
  • Fax: 940-825-4899
Mailing address:
  • Phone: 940-825-3226
  • Fax: 940-825-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number02607
License Number StateTX

VIII. Authorized Official

Name: MR. RUSSELL WAYNE FENOGLIO
Title or Position: PRESIDENT
Credential: RPH
Phone: 940-825-3226