Provider Demographics
NPI:1487784674
Name:SVP INC.
Entity type:Organization
Organization Name:SVP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUGHBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-283-7300
Mailing Address - Street 1:720 N INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-7439
Mailing Address - Country:US
Mailing Address - Phone:817-283-5308
Mailing Address - Fax:817-283-2308
Practice Address - Street 1:720 N INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-7439
Practice Address - Country:US
Practice Address - Phone:817-283-5308
Practice Address - Fax:817-283-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163683336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4510512Medicaid
TX4510512Medicaid