1831626019 NPI number — PHARMACY

Table of content: (NPI 1831626019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831626019 NPI number — PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
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:
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:
1831626019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7612 CANAL ST
Provider Second Line Business Mailing Address:
C
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-654-6588
Provider Business Mailing Address Fax Number:
713-802-2338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7612 CANAL ST
Provider Second Line Business Practice Location Address:
C
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-654-6588
Provider Business Practice Location Address Fax Number:
713-802-2338
Provider Enumeration Date:
05/18/2017

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
COEDROND
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
832-654-6588

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com