Provider Demographics
NPI:1285779199
Name:LORD AND A. PHARMACY
Entity type:Organization
Organization Name:LORD AND A. PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:ADAEZE
Authorized Official - Middle Name:V
Authorized Official - Last Name:MOGHALU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-421-3133
Mailing Address - Street 1:2949 MARTIN LUTHER KING JR BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-6317
Mailing Address - Country:US
Mailing Address - Phone:214-421-3133
Mailing Address - Fax:214-421-3160
Practice Address - Street 1:2949 MARTIN LUTHER KING JR BLVD STE 1
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-6317
Practice Address - Country:US
Practice Address - Phone:214-421-3133
Practice Address - Fax:214-421-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144528Medicaid