# PROVIDERX OF WACO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ProvideRx of Waco
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932413366
- **Authorized official:** TRACY WILSON (VP OF OPERATIONS)
- **Authorized official phone:** (817) 310-5554

## Contact information

- **Practice address:** 1404 S NEW RD STE 200, WACO, TX 76711-1335
- **Practice address phone:** (254) 523-4596
- **Practice address fax:** (866) 426-2198
- **Mailing address:** PO BOX 2176, FORNEY, TX 75126-2176
- **Mailing address phone:** (817) 310-5554
- **Mailing address fax:** (817) 756-1101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 26988 | TX | Yes |

## Other

- **Enumeration date:** 07/27/2010
- **Last updated:** 12/19/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5900572 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |