Healthcare Provider Details

I. General information

NPI: 1972589836
Provider Name (Legal Business Name): WBORO PHARMACY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CHARLIE DRIVE
WHITESBORO TX
76273
US

IV. Provider business mailing address

PO BOX 2407
SHERMAN TX
75091
US

V. Phone/Fax

Practice location:
  • Phone: 903-564-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number23828
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number23828
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number23828
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number23828
License Number StateTX

VIII. Authorized Official

Name: RHONDA S HINDSLEY
Title or Position: SECRETARY
Credential:
Phone: 903-893-0677