# PHARMACY CARE USA OF ADDISON, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Pharmacy Care USA of Addison, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669805628
- **Authorized official:** DORIS PETEK-GOMERSALL (SVP CORPORATE COMPLIANCE)
- **Authorized official phone:** (970) 250-2044

## Contact information

- **Practice address:** 4500 RATLIFF LANE, SUITE 102, ADDISON, TX 75001
- **Practice address phone:** (972) 388-1800
- **Practice address fax:** (877) 505-7999
- **Mailing address:** P.O. BOX 365, HYDRO, OK 73048
- **Mailing address phone:** (972) 388-1800
- **Mailing address fax:** (877) 505-7999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 28672 | TX | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/14/2013
- **Last updated:** 02/28/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2141466 | PK | — |