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General NPI Number Information
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NPI Number | 1073618302
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Entity Type | Organization
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Legal Business Name | MEDI-PARK PHARMACY
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 1920 MEDI PARK DR
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City | AMARILLO
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State | TX
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Zip | 79106-2104
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Country | US
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Telephone | 806-359-5496
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Fax | 806-355-9533
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Provider Business Mailing Address
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Address Line | 1920 MEDI PARK DR
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City | AMARILLO
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State | TX
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Zip | 79106-2104
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Country | US
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Telephone | 806-359-5496
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Fax | 806-355-9533
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Authorized Official
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Title or Position | OWNER-PHARMACIST
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Name | MR. GERALD RAYMOND PANDOLFI
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Credential | RPH.
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Telephone | 806-359-5496
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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 | 14575
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License Number State | TX
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