Provider Demographics
NPI:1124506894
Name:AMARILLO DIAGNOSTIC CLINIC RX INC
Entity type:Organization
Organization Name:AMARILLO DIAGNOSTIC CLINIC RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:806-353-2200
Mailing Address - Street 1:PO BOX 10003
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-0003
Mailing Address - Country:US
Mailing Address - Phone:806-353-2200
Mailing Address - Fax:
Practice Address - Street 1:6700 SW 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1701
Practice Address - Country:US
Practice Address - Phone:806-358-0331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150913336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1468594Medicaid