Provider Demographics
NPI:1104235654
Name:PHARMAX PHARMACY
Entity type:Organization
Organization Name:PHARMAX PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMD
Authorized Official - Prefix:DR
Authorized Official - First Name:TRINH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-693-1098
Mailing Address - Street 1:3250 W WALNUT ST
Mailing Address - Street 2:STE 106
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6307
Mailing Address - Country:US
Mailing Address - Phone:972-487-2252
Mailing Address - Fax:
Practice Address - Street 1:3250 W WALNUT ST
Practice Address - Street 2:STE 106
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6307
Practice Address - Country:US
Practice Address - Phone:972-487-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty