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General NPI Number Information
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NPI Number | 1124172572
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Entity Type | Organization
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Legal Business Name | PHARM NACOGDOCHES ACQUISITION LLC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 212 NORTH ST STE B
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City | NACOGDOCHES
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State | TX
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Zip | 75961
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Country | US
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Telephone | 817-442-0484
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Fax | 817-977-5086
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Provider Business Mailing Address
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Address Line | 212 NORTH ST STE B
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City | NACOGDOCHES
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State | TX
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Zip | 75961
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Country | US
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Telephone | 936-569-6430
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Fax | 817-977-5086
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Authorized Official
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Title or Position | OFFICER
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Name | MATTHEW FINN
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Credential |
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Telephone | 817-442-0484
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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 | 12958
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License Number State | TX
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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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