MEDICARE: MEDICAL CENTER EAST 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	13506	TX
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4586193	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184774424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER EAST PHARMACY

Provider Business Mailing Address
First Line	:	7112 LYONS AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-5361
Country	:	US
Telephone Number	:	713-675-2625
Fax Number	:

Provider Business Practice Location Address
First Line	:	7112 LYONS AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-5361
Country	:	US
Telephone Number	:	713-675-2625
Fax Number	:

Authorized Official
Title or Position	:	PIC AND OWNER
Name	:	EVA AU
Credential	:	RPH
Telephone Number	:	713-675-2625

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	06/17/2008

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Directions to “MEDICAL CENTER EAST PHARMACY ” Practice Location

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