MEDICARE: PARK PLACE 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	183500000X	Pharmacist	13975	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538381801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK PLACE PHARMACY

Provider Business Mailing Address
First Line	:	8000 PARK PLACE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-4644
Country	:	US
Telephone Number	:	713-643-1930
Fax Number	:	713-649-4212

Provider Business Practice Location Address
First Line	:	8000 PARK PLACE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-4644
Country	:	US
Telephone Number	:	713-643-1930
Fax Number	:	713-649-4212

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WILLIAM HOWARD DAHLQUIST
Credential	:
Telephone Number	:	713-643-1930

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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Directions to “PARK PLACE PHARMACY ” Practice Location

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