Provider Demographics
NPI:1306426234
Name:CROWN PHARMACY LLC
Entity type:Organization
Organization Name:CROWN PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GORLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-999-1772
Mailing Address - Street 1:26795 US HIGHWAY 380 E STE 800
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7852
Mailing Address - Country:US
Mailing Address - Phone:972-999-1772
Mailing Address - Fax:972-999-1779
Practice Address - Street 1:26795 US HIGHWAY 380 E STE 800
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-7852
Practice Address - Country:US
Practice Address - Phone:832-439-5325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy