1720409600 NPI number — TEXAS HEALTH RX, LLC

Table of content: (NPI 1720409600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720409600 NPI number — TEXAS HEALTH RX, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS HEALTH RX, LLC
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:
1720409600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26107 INTERSTATE 45 N
Provider Second Line Business Mailing Address:
SUITE A1
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-419-8820
Provider Business Mailing Address Fax Number:
281-419-8830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8901 FM 1960 RD W
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-4125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-419-8820
Provider Business Practice Location Address Fax Number:
281-419-8833
Provider Enumeration Date:
12/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HAQUE
Authorized Official First Name:
KHANDOKER
Authorized Official Middle Name:
RAFIQUL
Authorized Official Title or Position:
PHARMACY OWNER
Authorized Official Telephone Number:
281-691-0419

Provider Taxonomy Codes

  • Taxonomy code: 183500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10202677 . This is a "DEPARTMENT OF PUBLIC SAFETY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 28860 . This is a "TEXAS STATE BOARD OF PHARMACY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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