Provider Demographics
NPI:1124604178
Name:TWENTYONE 12 LLC
Entity type:Organization
Organization Name:TWENTYONE 12 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-475-4114
Mailing Address - Street 1:7651 ELDORADO PKWY STE 100A
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1735
Mailing Address - Country:US
Mailing Address - Phone:214-842-8565
Mailing Address - Fax:214-842-8566
Practice Address - Street 1:7651 ELDORADO PKWY STE 100A
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-1735
Practice Address - Country:US
Practice Address - Phone:214-842-8565
Practice Address - Fax:214-842-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-21
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy