Healthcare Provider Details

I. General information

NPI: 1235148255
Provider Name (Legal Business Name): HEALTH AND HUMAN SERVICES COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N DICKINSON DR # 318
RUSK TX
75785
US

IV. Provider business mailing address

PO BOX 138 805 NORTH DICKINSON
RUSK TX
75785
US

V. Phone/Fax

Practice location:
  • Phone: 903-683-7170
  • Fax: 903-683-7996
Mailing address:
  • Phone: 903-683-7170
  • Fax: 903-683-5996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number06030
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMANDA FAUGHT
Title or Position: PHARMACIST - ACTING PHARMACY DIRECT
Credential:
Phone: 903-683-7093