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General NPI Number Information
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NPI Number | 1104235654
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Entity Type | Organization
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Legal Business Name | PHARMAX PHARMACY
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Dates
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Enumeration Date | 08/08/2014
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 3250 W WALNUT ST STE 106
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City | GARLAND
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State | TX
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Zip | 75042-6307
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Country | US
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Telephone | 972-487-2252
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 W WALNUT ST STE 106
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City | GARLAND
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State | TX
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Zip | 75042-6307
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Country | US
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Telephone | 972-487-2252
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Fax |
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Authorized Official
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Title or Position | PHARMD
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Name | DR. TRINH KIEU
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Credential |
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Telephone | 972-693-1098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 47252
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License Number State | TX
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