Organization
SS TYLER LP
Active
Other names
QVL PHARMACY 102
Organization subpart
No
Provider details
NPI number
Authorized official
GARY CHAD COLLINS (CEO)
(214) 624-3050
Entity
Organization
Contact information
Practice address
1321 S BECKHAM AVE, TYLER, TX 75701-3323
(903) 593-1706
(903) 593-5513
Mailing address
PO BOX 803493, DALLAS, TX 75380-3493
(214) 624-3073
(214) 989-7986
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
23909
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145570
—
TX
01
—
2097627
PK
—
Enumeration date
05/16/2006
Last updated
06/17/2014
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