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NPI Code Detail

MEDICARE: PRO MED PHARMACY

MEDICARE: PRO MED 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
13336L0003XLong Term Care Pharmacy
23336M0002XMail Order Pharmacy
33336C0003XCommunity/Retail Pharmacy27241TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12143046OTHERPK

General Provider Information

NPI Number : 1316377443
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRO MED PHARMACY
Provider Business Mailing Address
First Line : 6300 WESTPARK DR STE 210
Second Line :
City : HOUSTON
State : TX
Zip : 77057-7207
Country : US
Telephone Number : 713-592-6188
Fax Number : 713-592-6211
Provider Business Practice Location Address
First Line : 6300 WESTPARK DR STE 210
Second Line :
City : HOUSTON
State : TX
Zip : 77057-7207
Country : US
Telephone Number : 713-592-6188
Fax Number : 713-592-6211
Authorized Official
Title or Position : OWNER
Name : SHAJUIET WEAVER
Credential :
Telephone Number : 713-592-6288
Provider Enumeration Date : 11/27/2013
Last Update Date : 11/27/2013

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Directions to “PRO MED PHARMACY ” Practice Location

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