Provider Demographics
NPI:1184265498
Name:MEDCARE PHARMACY LLC
Entity type:Organization
Organization Name:MEDCARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:UMA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-794-0099
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-0710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3712 NEW MATHIS RD STE 1
Practice Address - Street 2:
Practice Address - City:ELMENDORF
Practice Address - State:TX
Practice Address - Zip Code:78112-6298
Practice Address - Country:US
Practice Address - Phone:210-794-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy