MEDICARE: HOPE PROFESSIONAL COMPOUNDING 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	3336C0004X	Compounding Pharmacy	27715	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5905104	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1770850521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE PROFESSIONAL COMPOUNDING PHARMACY INC

Provider Business Mailing Address
First Line	:	1642 S MASON RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-4563
Country	:	US
Telephone Number	:	281-693-4673
Fax Number	:	281-693-4671

Provider Business Practice Location Address
First Line	:	1642 S MASON RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-4563
Country	:	US
Telephone Number	:	281-693-4673
Fax Number	:	281-693-4671

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	MARIA HERNANDEZ
Credential	:
Telephone Number	:	281-693-4673

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	02/09/2012

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