Provider Demographics
NPI:1538271440
Name:UNLIMITED PHARMACY, LLC
Entity type:Organization
Organization Name:UNLIMITED PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-673-1526
Mailing Address - Street 1:2985 S HWY 360
Mailing Address - Street 2:STE 145
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052
Mailing Address - Country:US
Mailing Address - Phone:888-644-4998
Mailing Address - Fax:888-890-0038
Practice Address - Street 1:2985 S HWY 360
Practice Address - Street 2:STE 145
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052
Practice Address - Country:US
Practice Address - Phone:888-644-4998
Practice Address - Fax:888-890-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX271983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146262Medicaid
4537037OtherNCPDP PROVIDER IDENTIFICATION NUMBER