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General NPI Number Information
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NPI Number | 1730526898
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Entity Type | Organization
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Legal Business Name | COURAGE PHARMACY LLC
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 3200 14TH ST STE 404
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City | PLANO
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State | TX
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Zip | 75074-4423
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Country | US
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Telephone | 972-943-0628
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Fax | 972-943-0629
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Provider Business Mailing Address
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Address Line | 3200 14TH ST STE 404
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City | PLANO
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State | TX
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Zip | 75074-4423
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Country | US
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Telephone | 972-943-0628
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Fax | 972-943-0629
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Authorized Official
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Title or Position | PHARMACIST IN-CHARGE
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Name | VERA O EDEBIRI
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Credential | R.PH
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Telephone | 972-897-8445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28565
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License Number State | TX
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