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General NPI Number Information
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NPI Number | 1639669005
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Entity Type | Organization
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Legal Business Name | CC PHARMACY 3 LLC
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 3000 JOE DIMAGGIO BLVD STE 57
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City | ROUND ROCK
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State | TX
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Zip | 78665-3996
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Country | US
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Telephone | 737-202-4101
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Fax | 737-202-4104
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Provider Business Mailing Address
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Address Line | 3000 JOE DIMAGGIO BLVD SUITE #57
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City | ROUND ROCK
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State | TX
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Zip | 78665-3922
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Country | US
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Telephone | 737-202-4101
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Fax | 737-202-4104
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Authorized Official
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Title or Position | PHARMACIST
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Name | WARREN DEFORGE
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Credential |
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Telephone | 737-202-4101
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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 |
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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 | 31312
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License Number State | TX
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