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General NPI Number Information
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NPI Number | 1497271308
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Entity Type | Organization
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Legal Business Name | CALVARY PHARMACY INC
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 08/22/2017
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Provider Practice Location Address
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Address Line | 329 N HIGHWAY 67 STE 150
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City | CEDAR HILL
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State | TX
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Zip | 75104-2100
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Country | US
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Telephone | 972-637-4324
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Fax | 972-637-3425
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Provider Business Mailing Address
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Address Line | PO BOX 542393
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City | GRAND PRAIRIE
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State | TX
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Zip | 75054-2393
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Country | US
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Telephone | 816-797-3424
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Fax | 972-637-4325
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. WILKINSON O THOMAS
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Credential | PHD,RPH
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Telephone | 972-637-4324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 31556
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License Number State | TX
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