=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386229169
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDTECH LOCAL PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2021
-----------------------------------------------------
Last Update Date | 07/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2345 50TH ST STE 201
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79412-2565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-399-8805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2345 50TH ST STE 201
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79412-2565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-370-3721
-----------------------------------------------------
Fax | 806-300-0845
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR / PRESIDENT
-----------------------------------------------------
Name | ROBERT TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 806-590-0527
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------