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General NPI Number Information
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NPI Number | 1235676347
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Entity Type | Organization
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Legal Business Name | RED DOOR PHARMACY AND GIFTS LLC
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 2488 AVONDALE HASLET RD STE 168
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City | HASLET
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State | TX
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Zip | 76052-3220
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Country | US
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Telephone | 817-259-2636
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Fax | 817-259-2636
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Provider Business Mailing Address
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Address Line | 2488 AVONDALE HASLET RD STE 168
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City | HASLET
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State | TX
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Zip | 76052-3441
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Country | US
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Telephone | 903-466-4662
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Fax | 817-259-2636
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Authorized Official
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Title or Position | OWNER, PHARMACIST IN CHARGE
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Name | RANDY SHIPP
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Credential | PHARMD
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Telephone | 817-259-1463
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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 | 31211
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License Number State | TX
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