Provider Demographics
NPI:1679134845
Name:MCMAHAN PHARMACY SERVICES, INC.
Entity type:Organization
Organization Name:MCMAHAN PHARMACY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:325-648-2484
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844-0389
Mailing Address - Country:US
Mailing Address - Phone:325-648-2484
Mailing Address - Fax:855-899-4147
Practice Address - Street 1:1503 W FRONT ST
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-2056
Practice Address - Country:US
Practice Address - Phone:325-648-2484
Practice Address - Fax:855-899-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141499Medicaid