SHALLOWATER PHARMACY, LLC
Suppliers at 12 St, Shallowater, TX

License number
Texas 28431
Category
Suppliers
Type
Community/Retail Pharmacy
Owner
Name: MR. MICAH GLENN PRATT PHARM D
Title: OWNER
Phone: (806) 385-4491
Address
Address
1502 12Th St STE B, Shallowater, TX 79363
National Provider ID: 1396947024
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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SHALLOWATER PHARMACY, LLC

Shallowater, TX

Status:
Inactive
Industry:
Ret Drugs/Sundries
Doing business as:
Shallowater Pharmacy<br>Leader Drug Store
Registration:
Dec 7, 2011
Addresses:
1502 12 St STE B, Shallowater, TX 79363 (Mailing)
703 Ave F, Shallowater, TX 79363
State ID:
0801517200
Business type:
Domestic Limited Liability Company (LLC)
Pharmacists:
Micah Pratt Member, Owner, Pharmacist, inactive, 1502 12 St STE B, Shallowater, TX 79363,Lauren Cline Pharmacist, inactive,Kelly Pratt Director Of Pharmacy, Owner, Principal, inactive,...
TIN:
32045912642