<Unavail>

LBN: Mark A Tackett
<Unavail> is an health care organization with primary practice located at 138 College Park Dr Ste 130 , Weatherford TX 76086-6372. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Mark A Tackett can be contacted via phone (817) 341-7046, or through Penny, Tara via phone (817) 341-7046.

Contact Information

Primary practice address
138 College Park Dr Ste 130 Weatherford TX 76086-6372
Phone: (817) 341-7046
Fax: (817) 341-7380
Website:
Map and Directions
Authorized official contact:
Name: Penny, Tara PHARM D
Phone: (817) 341-7046

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 27110 Texas
Suppliers / Compounding Pharmacy 3336C0004X

Profile Details

NPI number 1538471776
LBN Legal business name Mark A Tackett
DBA Doing business as <Unavail>
Authorized official Penny, Tara PHARM D
Entity Organization
Organization subpart 1 No
Enumeration date Jul 3rd, 2010
Last updated Jun 9th, 2016 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1538471776 NPPES
Texas MEDICAID 148282
Texas Other 2125348

Popular Providers