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General NPI Number Information
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NPI Number | 1801026638
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Entity Type | Organization
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Legal Business Name | TXEX MED LLC
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 405 HWY 281 SOUTH
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City | JOHNSON CITY
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State | TX
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Zip | 78636
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Country | US
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Telephone | 830-868-7185
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Fax | 830-868-7183
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Provider Business Mailing Address
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Address Line | PO BOX 433
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City | JOHNSON CITY
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State | TX
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Zip | 78636-0433
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Country | US
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Telephone | 830-868-7185
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Fax | 830-868-7183
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | PHIL LIETZ
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Credential | RPH
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Telephone | 830-868-7185
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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 | 28451
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License Number State | TX
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