Provider Demographics
NPI:1194123067
Name:S & L PHARMACY TERRELL INC
Entity type:Organization
Organization Name:S & L PHARMACY TERRELL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALFITI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-627-5400
Mailing Address - Street 1:601 W. MOORE AVENUE
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160
Mailing Address - Country:US
Mailing Address - Phone:972-563-3311
Mailing Address - Fax:972-563-5808
Practice Address - Street 1:601 W MOORE AVE
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3123
Practice Address - Country:US
Practice Address - Phone:972-563-3311
Practice Address - Fax:972-563-5808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX301213336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148514Medicaid
2149679OtherPK