Organization
PAVILION PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL LIEB (PRESIDENT)
(214) 947-7511
Entity
Organization
Contact information
Practice address
221 W COLORADO BLVD, SUITE 445, DALLAS, TX 75208-2363
(214) 947-2435
(214) 947-2436
Mailing address
221 W COLORADO BLVD, SUITE 445, DALLAS, TX 75208-2363
(214) 947-2435
(214) 947-2436
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
13542
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143603
—
TX
01
—
4580684
NABP
—
Enumeration date
09/09/2005
Last updated
03/07/2023
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