MEDICARE: C & L PHARMACY

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	29328	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2103965	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134231046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C & L PHARMACY

Provider Business Mailing Address
First Line	:	5600 MYKAWA
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033
Country	:	US
Telephone Number	:	713-641-3414
Fax Number	:	713-641-3603

Provider Business Practice Location Address
First Line	:	5600 MYKAWA
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033
Country	:	US
Telephone Number	:	713-641-3414
Fax Number	:	713-641-3603

Authorized Official
Title or Position	:	OWNER, RPH
Name	:	LINDA MARIE DAVIS
Credential	:	R.PH.
Telephone Number	:	713-641-3414

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/03/2019

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Directions to “C & L PHARMACY ” Practice Location

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