Provider Demographics
NPI:1285710319
Name:SALFITI SPRINGTOWN PHARMACY, LLC
Entity type:Organization
Organization Name:SALFITI SPRINGTOWN PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
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:817-532-6112
Mailing Address - Street 1:820 E MCCART ST STE C
Mailing Address - Street 2:
Mailing Address - City:KRUM
Mailing Address - State:TX
Mailing Address - Zip Code:76249-5634
Mailing Address - Country:US
Mailing Address - Phone:817-220-7927
Mailing Address - Fax:817-220-1294
Practice Address - Street 1:209 W HIGHWAY 199 STE 103
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082-2648
Practice Address - Country:US
Practice Address - Phone:817-220-7927
Practice Address - Fax:817-220-1294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
TX302723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155734OtherPK
TX142416Medicaid