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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