| NPI | 1932413366 |
|---|---|
| Doing Business As | PROVIDERX OF WACO |
| Entity Type | Organization |
| Authorized Contact | TRACY WILSON VP Of Operations 817-310-5554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: TX 26988) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2012-12-19 |