1093016362 NPI number — A HOLISTIC YOU PHARMACY

Table of content: (NPI 1093016362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093016362 NPI number — A HOLISTIC YOU PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A HOLISTIC YOU 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:
Provider Other Organization Name Type Code:
6
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:
1093016362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5826 NEW TERRITORY BLVD
Provider Second Line Business Mailing Address:
SUITE 613
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-5948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-997-1644
Provider Business Mailing Address Fax Number:
281-997-1643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9330 BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584-7891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-997-1644
Provider Business Practice Location Address Fax Number:
281-997-1643
Provider Enumeration Date:
11/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WIGGINS III
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
281-997-1644

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  26991 , 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: 5901651 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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