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General NPI Number Information
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NPI Number | 1467978767
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Entity Type | Organization
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Legal Business Name | ENTERPRISE PHARMACY NETWORK,LLC
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 802 TEXAS PKWY STE 2A
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City | STAFFORD
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State | TX
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Zip | 77477-6400
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Country | US
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Telephone | 346-304-2909
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Fax | 346-304-2909
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Provider Business Mailing Address
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Address Line | 802 TEXAS PKWY STE 2A
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City | STAFFORD
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State | TX
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Zip | 77477-6400
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Country | US
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Telephone | 346-304-2909
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Fax | 346-304-2909
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DALLAS BENTON DAVIS
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Credential |
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Telephone | 346-304-2909
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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 | 31519
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License Number State | TX
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