Healthcare Provider Details

I. General information

NPI: 1891844650
Provider Name (Legal Business Name): AFTERCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 FERRIS AVE
WAXAHACHIE TX
75165-2557
US

IV. Provider business mailing address

1001 FERRIS AVE
WAXAHACHIE TX
75165-2557
US

V. Phone/Fax

Practice location:
  • Phone: 972-923-2083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number12576
License Number StateTX

VIII. Authorized Official

Name: CHRIS G RUSSO
Title or Position: OWNER
Credential: RPH
Phone: 972-923-2083