Organization
CC PHARMACY 3 LLC
Active
Other names
CC Pharmacy 3
Organization subpart
No
Provider details
NPI number
Authorized official
WARREN DEFORGE (PHARMACIST)
(737) 202-4101
Entity
Organization
Contact information
Practice address
3000 JOE DIMAGGIO BLVD STE 57, ROUND ROCK, TX 78665-3996
(737) 202-4101
(737) 202-4104
Mailing address
3000 JOE DIMAGGIO BLVD, SUITE #57, ROUND ROCK, TX 78665-3922
(737) 202-4101
(737) 202-4104
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31312
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177684
PK
—
Enumeration date
05/11/2018
Last updated
07/19/2018
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