Organization
CITY DRUG STORE OF JACKSBORO, INC
Active
Organization
CITY DRUG STORE OF JACKSBORO, INC
Active
Other names
CITY DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHANDRA RENEE VANVACTER PHARMD (OWNER)
(940) 567-5576
Entity
Organization
Contact information
Practice address
104 E BELKNAP ST, JACKSBORO, TX 76458-2401
(940) 567-5576
(940) 567-3815
Mailing address
104 E BELKNAP ST, JACKSBORO, TX 76458-2401
(940) 567-5576
(940) 567-3815
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
139
TX
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120408
—
TX
01
—
2097943
PK
—
Enumeration date
08/31/2006
Last updated
02/19/2024
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