Organization
DEKALB PHARMACY LLC
Active
Other names
De Kalb Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JANET J. TIDWELL R.PH. (CO-OWNER)
(903) 667-0880
Entity
Organization
Contact information
Practice address
120 W FRONT ST, DE KALB, TX 75559-1308
(903) 667-0880
(309) 667-0909
Mailing address
120 W FRONT ST, DE KALB, TX 75559-1308
(903) 667-0880
(309) 667-0909
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
23839
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145478
—
TX
Enumeration date
06/10/2005
Last updated
08/30/2017
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