MEDICARE: ADDIS PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	27905	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5905229	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1639471543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDIS PHARMACY INC

Provider Business Mailing Address
First Line	:	3305 S MAYHILL ROAD
Second Line	:	SUITE 101
City	:	DENTON
State	:	TX
Zip	:	76208
Country	:	US
Telephone Number	:	940-382-0079
Fax Number	:	940-382-0002

Provider Business Practice Location Address
First Line	:	3305 S MAYHILL ROAD
Second Line	:	SUITE 101
City	:	DENTON
State	:	TX
Zip	:	76208
Country	:	US
Telephone Number	:	940-382-0079
Fax Number	:	940-382-0002

Authorized Official
Title or Position	:	OWNER
Name	:	NOON HAMID
Credential	:
Telephone Number	:	940-382-0079

Provider Enumeration Date	:	11/29/2010
Last Update Date	:	04/28/2023

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Directions to “ADDIS PHARMACY INC ” Practice Location

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