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General NPI Number Information
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NPI Number | 1598865800
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Entity Type | Organization
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Legal Business Name | EXECUTIVE HEALTHCARE
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 6303 FOREST PARK RD STE A 255
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City | DALLAS
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State | TX
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Zip | 75235-5450
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Country | US
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Telephone | 214-357-8889
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Fax | 214-357-8370
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Provider Business Mailing Address
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Address Line | PO BOX 797604
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City | DALLAS
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State | TX
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Zip | 75379-7604
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Country | US
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Telephone | 972-702-9310
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Fax | 972-458-7111
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Authorized Official
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Title or Position | OWNER
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Name | SEMYON NAROSOV
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Credential |
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Telephone | 214-357-8889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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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 | 26627
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License Number State | TX
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