Provider Demographics
NPI:1568682144
Name:ALLIED PHARMACY SERVICES, INC.
Entity type:Organization
Organization Name:ALLIED PHARMACY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:WAINE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-226-5050
Mailing Address - Street 1:801 STADIUM DR
Mailing Address - Street 2:SUITE # 111
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-6254
Mailing Address - Country:US
Mailing Address - Phone:817-226-5050
Mailing Address - Fax:817-860-1275
Practice Address - Street 1:801 STADIUM DR
Practice Address - Street 2:SUITE # 111
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6254
Practice Address - Country:US
Practice Address - Phone:817-226-5050
Practice Address - Fax:817-860-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176493336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17649OtherSTATE PHARMACY LICENSE