# DERAMED LTC PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DERHANN CO. LLC
- **Other names:** DeraMed Specialty Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1801414933
- **Legal business name:** DERHANN CO. LLC
- **Authorized official:** ADERONKE EFUNOGBON (DIRECTOR)
- **Authorized official phone:** (817) 592-3636

## Contact information

- **Practice address:** 1001 MATLOCK RD STE 105, MANSFIELD, TX 76063-3443
- **Practice address phone:** (817) 592-3636
- **Mailing address:** 1001 MATLOCK RD STE 105, MANSFIELD, TX 76063-3443
- **Mailing address phone:** (817) 592-3636

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/06/2020
- **Last updated:** 05/03/2024