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General NPI Number Information
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NPI Number | 1174934129
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Entity Type | Organization
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Legal Business Name | ROSS AVENUE PHARMACY LLC.
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 5101 ROSS AVE SUITE # 100
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City | DALLAS
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State | TX
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Zip | 75206-7762
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Country | US
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Telephone | 972-833-7999
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Fax | 972-755-4192
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Provider Business Mailing Address
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Address Line | 5101 ROSS AVENUE RD SUITE # 100
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City | DALLAS
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State | TX
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Zip | 75206-7762
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Country | US
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Telephone | 972-833-7999
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Fax | 972-755-4192
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | TAE HOON UHM
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Credential |
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Telephone | 972-833-7999
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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 | 29202
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 29202
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 29202
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License Number State | TX
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