MEDICARE: ECO PHARMACY OF SIENNA PLANATION 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	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy	29738	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2149815	OTHER		PK

General Provider Information

NPI Number	:	1124417605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECO PHARMACY OF SIENNA PLANATION LLC

Provider Business Mailing Address
First Line	:	8721 HIGHYWAY 6 SOUTH
Second Line	:	#200
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459
Country	:	US
Telephone Number	:	832-440-0085
Fax Number	:	832-440-7137

Provider Business Practice Location Address
First Line	:	8721 HIGHWAY 6 # 200
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-7151
Country	:	US
Telephone Number	:	832-440-0085
Fax Number	:	832-440-7137

Authorized Official
Title or Position	:	OWNER,AO
Name	:	JASMEET SINGH
Credential	:
Telephone Number	:	832-859-9323

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	04/21/2015

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