Provider Demographics
NPI:1114362340
Name:STAFFORD PHARMACY & DME LLC
Entity type:Organization
Organization Name:STAFFORD PHARMACY & DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:STAFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:PHARMACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-969-5901
Mailing Address - Street 1:2448 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5522
Mailing Address - Country:US
Mailing Address - Phone:281-969-5901
Mailing Address - Fax:832-539-6278
Practice Address - Street 1:2448 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5522
Practice Address - Country:US
Practice Address - Phone:281-969-5901
Practice Address - Fax:832-539-6278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy