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General NPI Number Information
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NPI Number | 1942393392
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Entity Type | Organization
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Legal Business Name | CANADIAN PHARMACY MANAGEMENT LLC
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 200 CHEYENNE AVE
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City | CANADIAN
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State | TX
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Zip | 79014-3018
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Country | US
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Telephone | 806-323-6171
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Fax | 806-323-6133
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Provider Business Mailing Address
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Address Line | 200 CHEYENNE AVE
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City | CANADIAN
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State | TX
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Zip | 79014-3018
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Country | US
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Telephone | 806-323-6171
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Fax | 806-323-6133
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Authorized Official
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Title or Position | PIC
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Name | BROOKE RICHARDSON
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Credential | RPH
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Telephone | 806-323-6171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 23282
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License Number State | TX
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