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General NPI Number Information
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NPI Number | 1821170002
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Entity Type | Organization
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Legal Business Name | THREE RIVERS PHARMACY, LLC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 101 W. THORNTON
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City | THREE RIVERS
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State | TX
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Zip | 78071
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Country | US
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Telephone | 361-786-3757
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Fax | 361-786-3279
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Provider Business Mailing Address
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Address Line | 813 HOSPITAL DR.
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City | ANDREWS
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State | TX
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Zip | 79714
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Country | US
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Telephone | 432-523-4861
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Fax | 432-524-4418
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | YANKTON WYATT
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Credential | PHARMD
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Telephone | 432-523-4861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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