Organization
UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS
Active
Parent organization
UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL
Other names
Moncrief Cancer Institute Retail Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL
Authorized official
MR. JEFF LITICKER PHARMD (PHARMACY MANAGER)
(214) 645-2681
Entity
Organization
Contact information
Practice address
400 W MAGNOLIA AVE STE 2500, FORT WORTH, TX 76104-7617
(817) 288-9756
(817) 288-0060
Mailing address
400 W MAGNOLIA AVE, STE 2500, FORT WORTH, TX 76104-7617
(817) 288-9756
(817) 288-0060
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29894
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2158721
PK
—
01
—
5918733
NCPDP
TX
Enumeration date
04/12/2016
Last updated
07/18/2017
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