Provider Demographics
NPI:1427137405
Name:MINYARD FOOD STORES INC.
Entity type:Organization
Organization Name:MINYARD FOOD STORES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BYARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-393-8700
Mailing Address - Street 1:1500 STEMMONS
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201
Mailing Address - Country:US
Mailing Address - Phone:940-565-0300
Mailing Address - Fax:940-383-3227
Practice Address - Street 1:1500 STEMMONS
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201
Practice Address - Country:US
Practice Address - Phone:940-565-0300
Practice Address - Fax:940-383-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX062763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142209Medicaid
TX4561266OtherNABP ID#
TX142209Medicaid