MEDICARE: QVL PHARMACY 141 LP

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	24292	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2098610	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710938345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QVL PHARMACY 141 LP

Provider Business Mailing Address
First Line	:	PO BOX 803493
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75380-3493
Country	:	US
Telephone Number	:	214-624-3073
Fax Number	:	214-989-7986

Provider Business Practice Location Address
First Line	:	6711 STELLA LINK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-4342
Country	:	US
Telephone Number	:	713-512-5998
Fax Number	:	713-491-4376

Authorized Official
Title or Position	:	CEO
Name	:	GARY CHAD COLLINS
Credential	:
Telephone Number	:	214-624-3050

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	06/17/2014

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