=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841263951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRO MED PHARMACIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 N TAYLOR
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79107-5279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-376-8245
-----------------------------------------------------
Fax | 806-379-7514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3615 SW 45TH AVE
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79109-5662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-379-7126
-----------------------------------------------------
Fax | 806-372-3984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT CEO
-----------------------------------------------------
Name | MR. DONALD R CHRYSLER JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 806-379-7126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0083114
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 13048
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------