MEDICARE: TOTAL PHARMACY AND COMPOUNDING SERVICES

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	25933	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4548042	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1144494014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL PHARMACY AND COMPOUNDING SERVICES

Provider Business Mailing Address
First Line	:	5020 MONTROSE BLVD
Second Line	:	STE 105
City	:	HOUSTON
State	:	TX
Zip	:	77006-6533
Country	:	US
Telephone Number	:	713-528-6337
Fax Number	:	713-528-7337

Provider Business Practice Location Address
First Line	:	5020 MONTROSE BLVD
Second Line	:	STE 105
City	:	HOUSTON
State	:	TX
Zip	:	77006-6533
Country	:	US
Telephone Number	:	713-528-6337
Fax Number	:	713-528-7337

Authorized Official
Title or Position	:	OWNER
Name	:	DOWARD GILBERT
Credential	:	PHRMD
Telephone Number	:	713-528-6337

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	01/14/2010

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