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General NPI Number Information
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NPI Number | 1467591396
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Entity Type | Organization
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Legal Business Name | CHRISTUS HEALTH ARK-LA-TEX
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 2604 SAINT MICHAEL DR STE 200
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City | TEXARKANA
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State | TX
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Zip | 75503-2378
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Country | US
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Telephone | 903-614-2200
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Fax | 903-614-2868
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Provider Business Mailing Address
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Address Line | 2604 SAINT MICHAEL DR STE 200
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City | TEXARKANA
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State | TX
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Zip | 75503-2378
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Country | US
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Telephone | 903-614-2200
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Fax | 903-614-2868
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON MATTHEW ADAMS
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Credential |
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Telephone | 702-738-4546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 35349
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License Number State | TX
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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 | 19509
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License Number State | TX
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