# AWALT-STEPHENSON DRUG

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LTC Dynamics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386883171
- **Authorized official:** VANCE OGLESBEE (PIC)
- **Authorized official phone:** (903) 389-2157

## Contact information

- **Practice address:** 201 E COMMERCE ST, STE A, FAIRFIELD, TX 75840-1509
- **Practice address phone:** (903) 389-2157
- **Practice address fax:** (903) 389-8939
- **Mailing address:** 201 E COMMERCE ST, STE A, FAIRFIELD, TX 75840-1509
- **Mailing address phone:** (903) 389-2157
- **Mailing address fax:** (903) 389-8939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 26308 | TX | Yes |

## Other

- **Enumeration date:** 02/18/2009
- **Last updated:** 04/12/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2119068 | PK | — |