Organization
AT HOME PHARMACY GRAND PRAIRIE LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY HASTY (OWNER CEO)
(214) 956-9770
Entity
Organization
Contact information
Practice address
4927 LAKE RIDGE PKWY STE 180, GRAND PRAIRIE, TX 75052
(214) 239-9106
(214) 239-9107
Mailing address
4927 LAKE RIDGE PKWY STE 180, GRAND PRAIRIE, TX 75052
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
24380
TX
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4539485
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/21/2006
Last updated
09/11/2025
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