Organization
SHALLOWATER PHARMACY, LLC
Active
Other names
Shallowater Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICAH GLENN PRATT PHARM D (OWNER)
(806) 385-4491
Entity
Organization
Contact information
Practice address
1502 12TH ST STE B, SHALLOWATER, TX 79363-5651
(806) 832-0250
(806) 832-0251
Mailing address
PO BOX 1129, SHALLOWATER, TX 79363-1129
(806) 832-0250
(806) 832-0251
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28431
TX
Other
Enumeration date
06/04/2007
Last updated
03/07/2013
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