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General NPI Number Information
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NPI Number | 1245537505
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Entity Type | Organization
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Legal Business Name | DALLAS HEALTHCARE PHARMACY LLC
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 4131 S BUCKNER BLVD SUITE A
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City | DALLAS
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State | TX
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Zip | 75227-4318
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Country | US
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Telephone | 214-388-5334
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Fax | 214-388-4355
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Provider Business Mailing Address
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Address Line | 4131 S BUCKNER BLVD SUITE A
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City | DALLAS
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State | TX
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Zip | 75227-4318
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Country | US
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Telephone | 214-388-5334
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Fax | 214-388-4355
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JUSTIN GRAVES
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Credential |
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Telephone | 469-387-5661
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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 | 27397
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License Number State | TX
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