MEDICARE: PRESCRIPTION DISPENSING LABORATORIES, 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	19531	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4501133	OTHER		NCPDP
2	34753	OTHER	TX	TEXAS STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1700859857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCRIPTION DISPENSING LABORATORIES, INC.

Provider Business Mailing Address
First Line	:	1513 E NEW HOPE DR BLDG E
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78641-5760
Country	:	US
Telephone Number	:	800-687-9014
Fax Number	:	210-494-3010

Provider Business Practice Location Address
First Line	:	1513 E NEW HOPE DR BLDG E
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78641-5760
Country	:	US
Telephone Number	:	800-687-9014
Fax Number	:	210-494-3010

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	RAYMOND L SOLANO
Credential	:	RPH
Telephone Number	:	800-687-9014

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	04/12/2024

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