1619988516 NPI number — RUMSEY PHARMACY INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619988516 NPI number — RUMSEY PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUMSEY PHARMACY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELAM ROAD PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619988516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9209 ELAM RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75217-4179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-391-6363
Provider Business Mailing Address Fax Number:
214-391-6004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9209 ELAM RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75217-4179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-391-6363
Provider Business Practice Location Address Fax Number:
214-391-6004
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUMSEY
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
PRESIDENT/PIC
Authorized Official Telephone Number:
214-391-6363

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  18613 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BE5575343 . This is a "US DEPT OF JUSTICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 144661 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18613 . This is a "TX BOARD OF PHARMACY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P0104591 . This is a "TX DEPT OF PUBLIC SAFETY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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