Provider Demographics
NPI:1902984602
Name:MINYARD FOOD STORES INC.
Entity Type:Organization
Organization Name:MINYARD FOOD STORES INC.
Other - Org Name:SACK 'N SAVE #224
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BYARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-393-8700
Mailing Address - Street 1:811 E HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-2209
Mailing Address - Country:US
Mailing Address - Phone:940-665-3008
Mailing Address - Fax:940-665-3415
Practice Address - Street 1:811 E HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2209
Practice Address - Country:US
Practice Address - Phone:940-665-3008
Practice Address - Fax:940-665-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4597653OtherNABP ID#
TX463916Medicaid
TX1268750014Medicare NSC