Provider Demographics
NPI:1902056427
Name:GENERX DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:GENERX DISCOUNT PHARMACY INC
Other - Org Name:GENERX DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOSU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:214-326-6541
Mailing Address - Street 1:1202 W PIONEER DR
Mailing Address - Street 2:STE 140
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7308
Mailing Address - Country:US
Mailing Address - Phone:972-417-8895
Mailing Address - Fax:927-259-3091
Practice Address - Street 1:1202 W PIONEER DR
Practice Address - Street 2:STE 140
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7308
Practice Address - Country:US
Practice Address - Phone:972-417-8895
Practice Address - Fax:972-259-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX262653336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148345Medicaid
2118119OtherPK