Provider Demographics
NPI:1386600195
Name:DRISCOLL PHARMACY INC
Entity type:Organization
Organization Name:DRISCOLL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:PARM D
Authorized Official - Phone:806-892-2561
Mailing Address - Street 1:816 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:IDALOU
Mailing Address - State:TX
Mailing Address - Zip Code:79329-9100
Mailing Address - Country:US
Mailing Address - Phone:806-892-2561
Mailing Address - Fax:806-892-3647
Practice Address - Street 1:816 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:IDALOU
Practice Address - State:TX
Practice Address - Zip Code:79329-9100
Practice Address - Country:US
Practice Address - Phone:806-892-2561
Practice Address - Fax:806-892-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144512Medicaid
2097884OtherPK
2097884OtherPK