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General NPI Number Information
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NPI Number | 1649846494
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Entity Type | Organization
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Legal Business Name | CRESTMARK PHARMACY SERVICES OF TEXAS LLC
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 220 ELLA ST
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City | TOMBALL
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State | TX
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Zip | 77375-5094
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Country | US
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Telephone | 346-273-0002
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Fax | 866-393-1507
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Provider Business Mailing Address
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Address Line | 433 N MACARTHUR AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-3767
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Country | US
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Telephone | 850-381-1433
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Fax | 850-872-1321
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | LEIGH ANNE MATHES
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Credential | PHARM D.
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Telephone | 850-381-1433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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