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General NPI Number Information
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NPI Number | 1174622005
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Entity Type | Organization
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Legal Business Name | PHARMPRORX LLC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 1105 SANTA FE DR STE 107
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City | WEATHERFORD
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State | TX
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Zip | 76086-5811
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Country | US
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Telephone | 682-262-1506
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Fax | 817-599-9673
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Provider Business Mailing Address
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Address Line | 1105 SANTA FE DR STE 107
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City | WEATHERFORD
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State | TX
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Zip | 76086-5811
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Country | US
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Telephone | 682-262-1506
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Fax | 972-332-3672
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Authorized Official
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Title or Position | PIC
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Name | TODD SILUK
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Credential |
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Telephone | 832-581-5886
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 28032
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License Number State | TX
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