1750712824 NPI number — ANCHOR PHARMACY LLC

Table of content: (NPI 1750712824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750712824 NPI number — ANCHOR PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANCHOR PHARMACY 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:
ANCHOR 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:
1750712824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
606 AVERY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-5713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-278-8669
Provider Business Mailing Address Fax Number:
832-278-8669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12669A BISSONNET ST
Provider Second Line Business Practice Location Address:
606 AVERY
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77099-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-751-7479
Provider Business Practice Location Address Fax Number:
832-278-8669
Provider Enumeration Date:
11/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
PIERRE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST IN CHARGE/OWNER
Authorized Official Telephone Number:
832-278-8669

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P06036 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2143078 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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