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General NPI Number Information
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NPI Number | 1992794473
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Entity Type | Organization
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Legal Business Name | MEDICINE CHEST PHARMACY INC
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 411 MAIN ST
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City | SULPHUR SPRINGS
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State | TX
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Zip | 75482-2762
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Country | US
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Telephone | 903-885-0821
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 796
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City | SULPHUR SPRINGS
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State | TX
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Zip | 75483-0796
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Country | US
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Telephone | 903-885-0821
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOE WEAVER
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Credential | RPH
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Telephone | 903-885-0821
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 21179
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License Number State | TX
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