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General NPI Number Information
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NPI Number | 1003229550
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Entity Type | Organization
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Legal Business Name | PHARMACY DEPOT, LLC
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 1119 W RANDOL MILL RD STE 104
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City | ARLINGTON
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State | TX
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Zip | 76012-6509
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Country | US
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Telephone | 682-323-5528
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Fax | 682-323-7022
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Provider Business Mailing Address
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Address Line | 1119 W RANDOL MILL RD STE 104
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City | ARLINGTON
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State | TX
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Zip | 76012-6509
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Country | US
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Telephone | 682-323-5528
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Fax | 682-323-7022
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Authorized Official
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Title or Position | MANAGER
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Name | KEVIN VU
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Credential |
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Telephone | 817-688-3778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 29155
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License Number State | TX
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