Provider Demographics
NPI:1144368135
Name:CARE FIRST PHARMACY LLC
Entity type:Organization
Organization Name:CARE FIRST PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-328-6421
Mailing Address - Street 1:PO BOX 671759
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-1759
Mailing Address - Country:US
Mailing Address - Phone:817-552-7630
Mailing Address - Fax:817-251-8139
Practice Address - Street 1:5492 ADAMS AVE PKWY
Practice Address - Street 2:
Practice Address - City:WASHINGTON TERRACE
Practice Address - State:UT
Practice Address - Zip Code:84405-4729
Practice Address - Country:US
Practice Address - Phone:801-479-4485
Practice Address - Fax:801-479-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122944OtherPK