Provider Demographics
NPI:1528285624
Name:VELASQUEZ GROUP LP
Entity type:Organization
Organization Name:VELASQUEZ GROUP LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-256-3111
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:79096
Mailing Address - Country:US
Mailing Address - Phone:806-826-5555
Mailing Address - Fax:806-826-5560
Practice Address - Street 1:1814 N BILL MACK
Practice Address - Street 2:
Practice Address - City:SHAMROCK
Practice Address - State:TX
Practice Address - Zip Code:79079
Practice Address - Country:US
Practice Address - Phone:806-256-3111
Practice Address - Fax:806-256-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX289313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146940OtherPK
TX141308Medicaid