MEDICARE: SSRX 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	:	1184291700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SSRX LLC

Provider Business Mailing Address
First Line	:	6330 WEST LOOP SOUTH
Second Line	:	SUITE 700, 7TH FLOOR
City	:	BELLAIRE
State	:	TX
Zip	:	77401-3480
Country	:	US
Telephone Number	:	713-660-8888
Fax Number	:	713-661-4828

Provider Business Practice Location Address
First Line	:	1111 MEDICAL PLAZA DR.
Second Line	:	STE. 160
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3480
Country	:	US
Telephone Number	:	713-660-8888
Fax Number	:	713-661-4828

Authorized Official
Title or Position	:	COO
Name	:	MARK GARY FETCENKO
Credential	:
Telephone Number	:	713-660-8888

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	06/10/2021

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Directions to “SSRX LLC ” Practice Location

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