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NPI Code Detail

MEDICARE: PRAETORIAN RX LLC

MEDICARE: PRAETORIAN RX LLC
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
12084P0800XPsychiatry Physician
21041C0700XClinical Social Worker
3183500000XPharmacist
4207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1811424195
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRAETORIAN RX LLC
Provider Business Mailing Address
First Line : 1880 S DAIRY ASHFORD RD STE 106
Second Line :
City : HOUSTON
State : TX
Zip : 77077-4759
Country : US
Telephone Number : 303-524-5972
Fax Number : 813-279-2728
Provider Business Practice Location Address
First Line : 1880 S DAIRY ASHFORD RD STE 106
Second Line :
City : HOUSTON
State : TX
Zip : 77077-4759
Country : US
Telephone Number : 303-524-5972
Fax Number : 813-279-2728
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : KELYN LANIER
Credential :
Telephone Number : 303-524-5972
Provider Enumeration Date : 05/17/2017
Last Update Date : 07/21/2022

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Directions to “PRAETORIAN RX LLC ” Practice Location

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