Provider Demographics
NPI:1093114134
Name:DALLAS COUNTY MENTAL HEALTH & MENTAL RETARDATION CENTER
Entity type:Organization
Organization Name:DALLAS COUNTY MENTAL HEALTH & MENTAL RETARDATION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MIN SEO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEON KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-743-6180
Mailing Address - Street 1:3242 REMOND DR
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211
Mailing Address - Country:US
Mailing Address - Phone:214-743-6180
Mailing Address - Fax:469-200-1956
Practice Address - Street 1:1020 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1527
Practice Address - Country:US
Practice Address - Phone:214-330-2424
Practice Address - Fax:214-330-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX294143336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147305OtherPK