Provider Demographics
NPI:1699290577
Name:DLB PHARMACY LLC
Entity type:Organization
Organization Name:DLB PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MOTLOW
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:901-921-5445
Mailing Address - Street 1:1801 N HAMPTON RD STE 340
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8317
Mailing Address - Country:US
Mailing Address - Phone:214-984-5230
Mailing Address - Fax:214-206-0160
Practice Address - Street 1:1801 N HAMPTON
Practice Address - Street 2:SUITE 340
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:214-984-5230
Practice Address - Fax:214-206-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy