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General NPI Number Information
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NPI Number | 1184937286
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Entity Type | Organization
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Legal Business Name | CROSSROADS PHARMACY
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Dates
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Enumeration Date | 07/17/2010
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 3220 GUS THOMASSON RD STE 237
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City | MESQUITE
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State | TX
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Zip | 75150-4051
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Country | US
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Telephone | 214-308-1963
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Fax | 214-432-8274
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Provider Business Mailing Address
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Address Line | PO BOX 271402
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City | DALLAS
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State | TX
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Zip | 75227-9579
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Country | US
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Telephone | 214-308-1963
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Fax | 214-432-8274
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | O'RITA SIDDALL
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Credential |
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Telephone | 214-308-1963
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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 |
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License Number State |
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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 | 27009
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License Number State | TX
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