# TELESIS-WALNUT PLACE NURSING HOME I LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walnut Place Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043315229
- **Authorized official:** MR. ROLIN SAMUEL GREEN JR. (PHARMACIST AND MANAGER)
- **Authorized official phone:** (214) 361-8923

## Contact information

- **Practice address:** 5515 GLEN LAKES DR, DALLAS, TX 75231-4309
- **Practice address phone:** (214) 361-8923
- **Practice address fax:** (214) 361-4281
- **Mailing address:** 5515 GLEN LAKES DR, DALLAS, TX 75231-4309
- **Mailing address phone:** (214) 361-8923
- **Mailing address fax:** (214) 361-4281

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 11588 | TX | Yes |

## Other

- **Enumeration date:** 09/13/2006
- **Last updated:** 10/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4571938 | OTHER ID NUMBER | — |