Provider Demographics
NPI:1730222738
Name:POWERS PHARMACY NO 1 INC
Entity type:Organization
Organization Name:POWERS PHARMACY NO 1 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-756-7923
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TX
Mailing Address - Zip Code:75563-0630
Mailing Address - Country:US
Mailing Address - Phone:903-756-7923
Mailing Address - Fax:903-756-7926
Practice Address - Street 1:702 WEST HOUSTON STREET
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TX
Practice Address - Zip Code:75563
Practice Address - Country:US
Practice Address - Phone:903-756-7923
Practice Address - Fax:903-756-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145117Medicaid
4519837OtherNCPDP
4434640001Medicare ID - Type Unspecified