Organization
QVL PHARMACY 144, LP
Active
Other names
QVL Pharmacy 144
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY ROSS POLIAKOFF (CHIEF EXECUTIVE OFFICER)
(903) 295-6800
Entity
Organization
Contact information
Practice address
2301 W WALNUT ST, GARLAND, TX 75042-6622
(972) 276-1439
(972) 276-5631
Mailing address
911 W LOOP 281, SUITE 408, LONGVIEW, TX 75604-2900
(903) 295-6800
(903) 295-3354
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
25055
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4540488
NCPDP
—
05
—
466270
—
TX
Enumeration date
05/16/2006
Last updated
08/22/2020
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