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General NPI Number Information
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NPI Number | 1033482641
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Entity Type | Organization
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Legal Business Name | IPSC MANAGEMENT LLC
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 610 E JEFFERSON BLVD # 110B
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City | DALLAS
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State | TX
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Zip | 75203-2750
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Country | US
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Telephone | 972-231-4888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 451269
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City | GARLAND
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State | TX
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Zip | 75045-1269
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STANLEY THOMAS
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Credential |
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Telephone | 214-403-5433
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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