Provider Demographics
NPI:1730344318
Name:VA CMOP
Entity type:Organization
Organization Name:VA CMOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PHARMACY TECHNICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-228-6230
Mailing Address - Street 1:2962 S LONGHORN DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-2118
Mailing Address - Country:US
Mailing Address - Phone:972-228-6230
Mailing Address - Fax:972-228-5646
Practice Address - Street 1:2962 S LONGHORN DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-2118
Practice Address - Country:US
Practice Address - Phone:972-228-6230
Practice Address - Fax:972-228-5646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1701-0654-2361-930261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA