Organization
CITY DRUG JEFFERSON TEXAS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN ALLEN BATES RPH (PRESIDENT)
(903) 665-2521
Entity
Organization
Contact information
Practice address
109 W LAFAYETTE ST, JEFFERSON, TX 75657-2205
(903) 665-2521
(903) 665-7422
Mailing address
PO BOX 856, JEFFERSON, TX 75657-0856
(903) 665-2521
(903) 665-7422
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
00141
TX
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120423
—
TX
05
—
17946601
—
TX
Enumeration date
05/23/2006
Last updated
10/08/2019
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