Provider Demographics
NPI:1487620001
Name:PHARMACY 20 INC
Entity type:Organization
Organization Name:PHARMACY 20 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHOR. OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:DIRK
Authorized Official - Last Name:PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-793-1633
Mailing Address - Street 1:1210 PINE ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-4410
Mailing Address - Country:US
Mailing Address - Phone:800-779-4550
Mailing Address - Fax:
Practice Address - Street 1:82 SPRUCE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2150
Practice Address - Country:US
Practice Address - Phone:800-779-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012267332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4177370001Medicare ID - Type Unspecified