Provider Demographics
NPI:1144544685
Name:KINDLE MAYBERRY INVESTMENT GROUP INC
Entity type:Organization
Organization Name:KINDLE MAYBERRY INVESTMENT GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-427-6442
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:TX
Mailing Address - Zip Code:75114-0100
Mailing Address - Country:US
Mailing Address - Phone:903-972-6442
Mailing Address - Fax:
Practice Address - Street 1:1317 HWY 175 STE 800
Practice Address - Street 2:
Practice Address - City:CRANDALL
Practice Address - State:TX
Practice Address - Zip Code:75114
Practice Address - Country:US
Practice Address - Phone:972-427-6442
Practice Address - Fax:972-427-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX268603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124524OtherPK