Organization
ALEDO MEDICINE STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRESTON HALL PHARMD (PRESIDENT)
(817) 441-2702
Entity
Organization
Contact information
Practice address
621 NORTH F M 1187, ALEDO, TX 76008-4206
(817) 441-2702
(817) 441-2708
Mailing address
PO BOX 1900, ALEDO, TX 76008-1900
(817) 441-2702
(817) 441-2708
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
23774
TX
3336C0004X
Compounding Pharmacy
23774
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145493
—
TX
Enumeration date
03/06/2007
Last updated
09/05/2014
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