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General NPI Number Information
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NPI Number | 1568951978
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Entity Type | Organization
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Legal Business Name | SRXPTX1 LLC
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 2000 N PLANO RD SUITE 113
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City | RICHARDSON
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State | TX
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Zip | 75082
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Country | US
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Telephone | 214-792-9682
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Fax | 214-792-9714
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Provider Business Mailing Address
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Address Line | 2000 N PLANO RD SUITE 113
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City | RICHARDSON
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State | TX
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Zip | 75082
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Country | US
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Telephone | 214-792-9682
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Fax | 214-792-9714
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Authorized Official
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Title or Position | OFFICER
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Name | MR. EVAN DAVID JOHNSON
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Credential |
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Telephone | 214-792-9682
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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 | 32009
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License Number State | TX
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