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General NPI Number Information
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NPI Number | 1720318058
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Entity Type | Organization
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Legal Business Name | IMMUNITY ACCESS LLC
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 01/08/2010
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Provider Practice Location Address
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Address Line | 7916 ALEXANDRIA AVE
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City | AMARILLO
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State | TX
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Zip | 79118-6195
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Country | US
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Telephone | 806-418-2470
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Fax |
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Provider Business Mailing Address
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Address Line | 7916 ALEXANDRIA AVE
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City | AMARILLO
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State | TX
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Zip | 79118-6195
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Country | US
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Telephone | 806-418-2470
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | JOSEPH DEBONS
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Credential |
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Telephone | 806-418-2470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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