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General NPI Number Information
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NPI Number | 1649291204
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Entity Type | Organization
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Legal Business Name | MEDICINE CHEST NO 132 LLC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 411 MAIN ST
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City | SULPHUR SPRINGS
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State | TX
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Zip | 75482-2762
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Country | US
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Telephone | 903-885-0821
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 796
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City | SULPHUR SPRINGS
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State | TX
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Zip | 75483-0796
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Country | US
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Telephone | 903-885-0821
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, RPH
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Name | JOE WEAVER
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Credential | CPHT, BBA
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Telephone | 903-885-0821
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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 | 27307
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License Number State | TX
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