MEDICARE: CREATIVE PHARMACY MGMT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3336M0002X	Mail Order Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1619438975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE PHARMACY MGMT, LLC

Provider Business Mailing Address
First Line	:	4705 AVENUE H STE C
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-2065
Country	:	US
Telephone Number	:	832-471-6121
Fax Number	:	832-759-5763

Provider Business Practice Location Address
First Line	:	4705 AVENUE H STE C
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-2065
Country	:	US
Telephone Number	:	832-471-6121
Fax Number	:	832-759-5763

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DENNOLE FORD
Credential	:
Telephone Number	:	832-471-6121

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	08/19/2024

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