Organization
AWALT-STEPHENSON DRUG
Active
Other names
LTC Dynamics
Organization subpart
No
Provider details
NPI number
Authorized official
VANCE OGLESBEE (PIC)
(903) 389-2157
Entity
Organization
Contact information
Practice address
201 E COMMERCE ST, STE A, FAIRFIELD, TX 75840-1509
(903) 389-2157
(903) 389-8939
Mailing address
201 E COMMERCE ST, STE A, FAIRFIELD, TX 75840-1509
(903) 389-2157
(903) 389-8939
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
26308
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2119068
PK
—
Enumeration date
02/18/2009
Last updated
04/12/2016
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