Provider Demographics
NPI:1104929249
Name:MAXWELL PHARMACY INC
Entity type:Organization
Organization Name:MAXWELL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-876-2323
Mailing Address - Street 1:626 N HWY 155
Mailing Address - Street 2:PO BOX 726
Mailing Address - City:FRANKSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75763
Mailing Address - Country:US
Mailing Address - Phone:903-876-2323
Mailing Address - Fax:903-876-4115
Practice Address - Street 1:626 N HWY 155
Practice Address - Street 2:
Practice Address - City:FRANKSTON
Practice Address - State:TX
Practice Address - Zip Code:75763
Practice Address - Country:US
Practice Address - Phone:903-876-2323
Practice Address - Fax:903-876-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210063336C0003X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145145Medicaid
2103752OtherPK
TX145145Medicaid