# FIFTY 50 MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fifty50 Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376797704
- **Authorized official:** MAXINE WILSON (GM)
- **Authorized official phone:** (972) 243-2727

## Contact information

- **Practice address:** 1411 E SANDY LAKE RD STE 120, COPPELL, TX 75019-7947
- **Practice address phone:** (972) 243-2727
- **Practice address fax:** (972) 243-3111
- **Mailing address:** 1411 E SANDY LAKE RD STE 120, COPPELL, TX 75019-7947
- **Mailing address phone:** (972) 243-2727
- **Mailing address fax:** (972) 243-3111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 26217 | TX | Yes |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 11/12/2008
- **Last updated:** 05/08/2023