Organization
MPRX, INC
Active
Other names
Medical Park Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JACK R MUNN RPH (OWNER)
(214) 221-8181
Entity
Organization
Contact information
Practice address
2508 OAK LAWN AVE, DALLAS, TX 75219-4018
(214) 221-8181
(214) 221-8282
Mailing address
2508 OAK LAWN AVE, DALLAS, TX 75219-4018
(214) 221-8181
(214) 221-8282
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
12801
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
12801
TX
333600000X
Pharmacy
12801
TX
3336H0001X
Home Infusion Therapy Pharmacy
Primary
12801
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016816301
—
TX
05
—
016816304
—
TX
01
—
514555
BCBS
TX
01
—
750176
BLUE CROSS BLUE SHIELD
TX
Enumeration date
11/14/2005
Last updated
02/09/2009
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