Organization
LJP INC
Active
Other names
COUNTRY DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
TOM HICKMAN PHARMACIST (PRESIDENT)
(325) 773-2441
Entity
Organization
Contact information
Practice address
1517 COLUMBIA ST, STAMFORD, TX 79553-6832
(325) 773-2441
(325) 733-3878
Mailing address
1517 COLUMBIA ST, STAMFORD, TX 79553-6832
(325) 773-2441
(325) 733-3878
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4001
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140407
—
TX
01
—
2103014
PK
—
Enumeration date
02/15/2007
Last updated
02/20/2017
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