1053515239 NPI number — RXPROS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053515239 NPI number — RXPROS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RXPROS
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:
WEST BELLFORT PHARMACY
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:
1053515239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8737 W BELLFORT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77031-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-771-4343
Provider Business Mailing Address Fax Number:
713-771-4350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8737 W BELLFORT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77031-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-771-4343
Provider Business Practice Location Address Fax Number:
713-771-4350
Provider Enumeration Date:
06/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCARTER
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-771-4343

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  38115 , 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: 145366 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".