MEDICARE: TABB PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	27589	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5903782	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1073893038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TABB PHARMACY LLC

Provider Business Mailing Address
First Line	:	8608 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1301
Country	:	US
Telephone Number	:	713-772-8222
Fax Number	:	713-772-8223

Provider Business Practice Location Address
First Line	:	8608 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1301
Country	:	US
Telephone Number	:	713-772-8222
Fax Number	:	713-772-8223

Authorized Official
Title or Position	:	OWNER
Name	:	JUDITH IKWUAGWU
Credential	:
Telephone Number	:	713-772-8222

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	01/24/2025

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Directions to “TABB PHARMACY LLC ” Practice Location

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