Provider Demographics
NPI:1316439748
Name:AMBIKA PHARMACY LLC
Entity type:Organization
Organization Name:AMBIKA PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-423-3636
Mailing Address - Street 1:2300 MATLOCK RD
Mailing Address - Street 2:SUITE 37
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5019
Mailing Address - Country:US
Mailing Address - Phone:682-422-4421
Mailing Address - Fax:682-292-1659
Practice Address - Street 1:2300 MATLOCK RD STE 37
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5018
Practice Address - Country:US
Practice Address - Phone:682-422-4421
Practice Address - Fax:682-292-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32067333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177900OtherPK