MEDICARE: MERIT PHARMACY INC

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	26220	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2100403	OTHER		PK

General Provider Information

NPI Number	:	1578750964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIT PHARMACY INC

Provider Business Mailing Address
First Line	:	5620 E SAM HOUSTON PKWY N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3249
Country	:	US
Telephone Number	:	281-457-3838
Fax Number	:	281-457-3840

Provider Business Practice Location Address
First Line	:	5620 E SAM HOUSTON PKWY N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3249
Country	:	US
Telephone Number	:	281-457-3838
Fax Number	:	281-457-3840

Authorized Official
Title or Position	:	MANAGER
Name	:	IVOR JALLAH
Credential	:
Telephone Number	:	972-814-5738

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	03/02/2017

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Directions to “MERIT PHARMACY INC ” Practice Location

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