MEDICARE: MARK'S PHARMACY INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1457193500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK'S PHARMACY INCORPORATED

Provider Business Mailing Address
First Line	:	8150 BROOKRIVER DR STE 107
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4068
Country	:	US
Telephone Number	:	469-547-2419
Fax Number	:	469-547-2420

Provider Business Practice Location Address
First Line	:	8150 BROOKRIVER DR STE 107
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4068
Country	:	US
Telephone Number	:	469-547-2419
Fax Number	:	469-547-2420

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DEAN ELENDU
Credential	:	PHARMD
Telephone Number	:	972-352-0613

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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