Provider Demographics
NPI:1225791130
Name:TEXAS COMMUNITY PHARMACY SERVICES
Entity type:Organization
Organization Name:TEXAS COMMUNITY PHARMACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:940-382-1618
Mailing Address - Street 1:4400 TEASLEY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4651
Mailing Address - Country:US
Mailing Address - Phone:940-382-1618
Mailing Address - Fax:940-898-1986
Practice Address - Street 1:4400 TEASLEY LN STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-4651
Practice Address - Country:US
Practice Address - Phone:940-382-1618
Practice Address - Fax:940-898-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145120Medicaid