1033293162 NPI number — EXPERTISE PHARMACY

Table of content: (NPI 1033293162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033293162 NPI number — EXPERTISE PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXPERTISE PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FARMACIA DEL PUEBLO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033293162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1657
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLAIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77402-1657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8885 W BELLFORT ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77031-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-774-3331
Provider Business Practice Location Address Fax Number:
713-774-4440
Provider Enumeration Date:
10/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
CEDRIC
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-330-5044

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  25033 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 144839 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4507832 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".