Organization
HEBRON PHARMACY LLC
Active
Other names
HEBRON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PHUONG BUI (OWNER/AO)
(972) 394-7015
Entity
Organization
Contact information
Practice address
4100 FAIRWAY DR STE 500, SUITE #500, CARROLLTON, TX 75010-6525
(972) 394-7015
(972) 394-7016
Mailing address
4100 FAIRWAY DR STE 500, SUITE #500, CARROLLTON, TX 75010-6525
(972) 394-7015
(972) 394-7016
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
30841
TX
3336C0004X
Compounding Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149217
—
TX
01
—
2160061
PK
—
Enumeration date
05/12/2016
Last updated
07/19/2018
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