Healthcare Provider Details

I. General information

NPI: 1801158019
Provider Name (Legal Business Name): WTHFB TYLER.LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 E 5TH ST
TYLER TX
75701-3523
US

IV. Provider business mailing address

2415 E 5TH ST
TYLER TX
75701-3523
US

V. Phone/Fax

Practice location:
  • Phone: 903-593-1400
  • Fax:
Mailing address:
  • Phone: 903-593-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES EUBANKS
Title or Position: MANAGING MEMBER
Credential: RPH
Phone: 903-530-3300