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Organization
WYLIE PHARMACY LLC
Active
Organization
WYLIE PHARMACY LLC
Active
Other names
Wylie Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SRIKRISHNA BOPPANA (PIC)
(972) 429-9594
Entity
Organization
Contact information
Practice address
430 S HIGHWAY 78 STE 160, WYLIE, TX 75098-3974
(972) 429-9594
(972) 429-9482
Mailing address
430 S HIGHWAY 78, SUITE 160, WYLIE, TX 75098-3905
(972) 429-9594
(972) 429-9482
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28505
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146807
—
TX
01
—
2141040
PK
—
Enumeration date
07/11/2013
Last updated
01/14/2014
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