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General NPI Number Information
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NPI Number | 1396818290
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Entity Type | Organization
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Legal Business Name | MINYARD FOOD STORES INC.
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1220 N TOWN EAST BLVD
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City | MESQUITE
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State | TX
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Zip | 75150-7605
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Country | US
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Telephone | 972-279-1221
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Fax | 972-613-6047
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Provider Business Mailing Address
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Address Line | 1220 N TOWN EAST BLVD
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City | MESQUITE
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State | TX
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Zip | 75150-7605
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Country | US
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Telephone | 972-279-1221
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Fax | 972-613-6047
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | MR. MICHAEL D. BYARS
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Credential |
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Telephone | 97239383700
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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 | 12846
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License Number State | TX
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