MEDICARE: SCARSDALE 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

General Provider Information

NPI Number	:	1083277842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCARSDALE PHARMACY, LLC

Provider Business Mailing Address
First Line	:	12600 SCARSDALE BLVD STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-6271
Country	:	US
Telephone Number	:	281-481-6600
Fax Number	:	281-481-1931

Provider Business Practice Location Address
First Line	:	10655 FUQUA ST STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-2681
Country	:	US
Telephone Number	:	281-481-6600
Fax Number	:	281-481-1931

Authorized Official
Title or Position	:	PIC
Name	:	TUE TRAN
Credential	:
Telephone Number	:	281-481-6600

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	04/17/2019

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Directions to “SCARSDALE PHARMACY, LLC ” Practice Location

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