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General NPI Number Information
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NPI Number | 1295237543
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Entity Type | Organization
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Legal Business Name | SOCIETY OF ST. VINCENT DE PAUL CHARITABLE PHARMACY OF NORTH TEXAS, INC
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 5750 PINELAND DR
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City | DALLAS
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State | TX
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Zip | 75231-5300
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Country | US
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Telephone | 469-232-9902
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Fax | 469-533-0350
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Provider Business Mailing Address
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Address Line | 4310 GLENWICK LN
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City | DALLAS
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State | TX
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Zip | 75205-1035
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Country | US
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Telephone | 214-868-8944
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGING DIRECTOR
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Name | MR. CLARENCE HENRY HERMANN
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Credential |
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Telephone | 214-868-8944
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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 | 31881
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License Number State | TX
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