MEDICARE: TEXAS UNICARE 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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	29287	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2146160	OTHER		PK

General Provider Information

NPI Number	:	1518370808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS UNICARE PHARMACY LLC

Provider Business Mailing Address
First Line	:	2424 W HOLCOMBE BLVD
Second Line	:	SUITE 101
City	:	HOUSTON
State	:	TX
Zip	:	77030-1934
Country	:	US
Telephone Number	:	832-834-3222
Fax Number	:	832-834-4222

Provider Business Practice Location Address
First Line	:	2424 W HOLCOMBE BLVD STE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1933
Country	:	US
Telephone Number	:	832-834-3222
Fax Number	:	832-834-4222

Authorized Official
Title or Position	:	OWNER, PHCY MGR, PIC
Name	:	MOHAMED KASEB
Credential	:	RPH
Telephone Number	:	832-834-3218

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	08/21/2014

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Directions to “TEXAS UNICARE PHARMACY LLC ” Practice Location

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