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General NPI Number Information
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NPI Number | 1194419820
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Entity Type | Organization
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Legal Business Name | PMPTX LLC
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 1004 BROADWAY AVE STE A
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City | GLADEWATER
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State | TX
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Zip | 75647-2534
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Country | US
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Telephone | 903-374-2002
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Fax | 903-309-1031
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Provider Business Mailing Address
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Address Line | 1606 PEBBLE BEACH CT
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City | LONGVIEW
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State | TX
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Zip | 75605-2671
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Country | US
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Telephone | 917-539-7425
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Fax | 903-309-1031
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Authorized Official
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Title or Position | OWNER
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Name | KUMARI UNNATI YADAV
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Credential | PHARM.D
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Telephone | 903-374-2002
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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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