# HEALTH AND HUMAN SERVICES COMMISSION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RUSK STATE HOSPITAL PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235148255
- **Authorized official:** AMANDA FAUGHT (PHARMACIST - ACTING PHARMACY DIRECT)
- **Authorized official phone:** (903) 683-7093

## Contact information

- **Practice address:** 805 N DICKINSON DR \# 318, RUSK, TX 75785
- **Practice address phone:** (903) 683-7170
- **Practice address fax:** (903) 683-7996
- **Mailing address:** PO BOX 138, 805 NORTH DICKINSON, RUSK, TX 75785
- **Mailing address phone:** (903) 683-7170
- **Mailing address fax:** (903) 683-5996

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336I0012X | Institutional Pharmacy | 06030 | TX | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 08/07/2006
- **Last updated:** 10/21/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 133331202 | — | TX |
| 01 | — | 2097694 | PK | — |