MEDICARE: THE MERCY PHARMACY 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	:	1386118966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MERCY PHARMACY LLC

Provider Business Mailing Address
First Line	:	4218 SAN FELIPE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-2902
Country	:	US
Telephone Number	:	833-781-8155
Fax Number	:	832-408-9859

Provider Business Practice Location Address
First Line	:	4218 SAN FELIPE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-2902
Country	:	US
Telephone Number	:	833-781-8155
Fax Number	:	832-408-9859

Authorized Official
Title or Position	:	MANAGER /OFFICER
Name	:	OMAR KHAN
Credential	:
Telephone Number	:	833-781-8155

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	02/20/2024

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Directions to “THE MERCY PHARMACY LLC ” Practice Location

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