Provider Demographics
NPI:1548694029
Name:HARVESTFIELD PHARMACY INC
Entity type:Organization
Organization Name:HARVESTFIELD PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADEWALE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-568-4208
Mailing Address - Street 1:201 W DEL MAR BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2238
Mailing Address - Country:US
Mailing Address - Phone:956-568-4208
Mailing Address - Fax:956-568-4213
Practice Address - Street 1:201 W DEL MAR BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2238
Practice Address - Country:US
Practice Address - Phone:956-568-4208
Practice Address - Fax:956-568-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX287493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141885OtherPK