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NPI Code Detail

MEDICARE: ELLA-MED INC

MEDICARE: ELLA-MED 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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy24331TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14539497OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1750323325
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELLA-MED INC
Provider Business Mailing Address
First Line : 3444 ELLA BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77018-6100
Country : US
Telephone Number : 713-956-1622
Fax Number : 713-956-5944
Provider Business Practice Location Address
First Line : 3444 ELLA BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77018-6100
Country : US
Telephone Number : 713-956-1622
Fax Number : 713-956-5944
Authorized Official
Title or Position : PIC OWNER
Name : TRANG PHAM
Credential :
Telephone Number : 713-956-1622
Provider Enumeration Date : 06/11/2006
Last Update Date : 11/17/2009

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Directions to “ELLA-MED INC ” Practice Location

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