Healthcare Provider Details

I. General information

NPI: 1518044338
Provider Name (Legal Business Name): MINYARD FOOD STORES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HALL RD
SEAGOVILLE TX
75159-2915
US

IV. Provider business mailing address

125 HALL RD
SEAGOVILLE TX
75159-2915
US

V. Phone/Fax

Practice location:
  • Phone: 972-287-1680
  • Fax: 972-287-2269
Mailing address:
  • Phone: 972-287-1680
  • Fax: 972-287-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number13163
License Number StateTX

VIII. Authorized Official

Name: MR. MICHAEL D. BYARS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 972-393-8700