=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598791428
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPERMONT PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 01/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 616 SOUTH WASHINGTON
-----------------------------------------------------
City | ASPERMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-989-2139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 804
-----------------------------------------------------
City | ASPERMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79502-0804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-989-2139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MRS. LEE ANN HAGINS
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 940-989-2139
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 24108
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 24108
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------