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General NPI Number Information
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NPI Number | 1003800160
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Entity Type | Organization
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Legal Business Name | CEDAR CREEK PHARMACY
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 606 S SEVEN POINTS DR
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City | SEVEN POINTS
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State | TX
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Zip | 75143-9117
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Country | US
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Telephone | 903-432-2223
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Fax | 903-432-2647
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Provider Business Mailing Address
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Address Line | 606 S SEVEN POINTS DR
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City | SEVEN POINTS
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State | TX
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Zip | 75143-9117
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Country | US
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Telephone | 903-432-2223
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Fax | 903-432-2647
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE/MANAGER
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Name | EDGAR JIMENEZ
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Credential | R.PH.
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Telephone | 903-432-3484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 04235
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License Number State | TX
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