Organization
IPSC MANAGEMENT LLC
Active
Other names
ATLANTIS PHARMACY #1
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY THOMAS (PRESIDENT)
(214) 403-5433
Entity
Organization
Contact information
Practice address
610 E JEFFERSON BLVD # 110B, DALLAS, TX 75203-2750
(972) 231-4888
Mailing address
PO BOX 451269, GARLAND, TX 75045-1269
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5905142
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/13/2012
Last updated
02/17/2012
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