Organization
CAREY PROSPERIE PHARMACY INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
2119 E 5TH ST, TYLER, TX 75701-3515
(903) 597-3383
(903) 597-2129
Mailing address
2119 E 5TH ST, TYLER, TX 75701-3515
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
13550
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4580367
OTHER ID NUMBER
—
05
—
4580367
—
TX
Enumeration date
02/21/2007
Last updated
06/27/2008
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