Provider Demographics
NPI:1063584555
Name:A & P PHARMACY INC
Entity type:Organization
Organization Name:A & P PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-491-9111
Mailing Address - Street 1:PO BOX 2088
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-4088
Mailing Address - Country:US
Mailing Address - Phone:817-222-1574
Mailing Address - Fax:817-491-1358
Practice Address - Street 1:2919 MARKUM DR
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117-4004
Practice Address - Country:US
Practice Address - Phone:817-222-1574
Practice Address - Fax:817-491-1358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX240013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4534384OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX145524AMedicaid