Organization
COVENANT PHARMACY LLC
Active
Other names
TRAIL CREEK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ROB ZACHARIAH (PARTNER)
(817) 684-9464
Entity
Organization
Contact information
Practice address
2700 TIBBETS DR, STE 200, BEDFORD, TX 76022-5928
(817) 684-9464
(817) 684-9287
Mailing address
2700 TIBBETS DR, STE 200, BEDFORD, TX 76022-5928
(817) 684-9464
(817) 684-9287
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28347
TX
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146739
—
TX
01
—
2139586
PK
—
Enumeration date
01/04/2008
Last updated
06/11/2015
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