MEDICARE: THE ELIXIR PHARMACY

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

General Provider Information

NPI Number	:	1952738734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ELIXIR PHARMACY

Provider Business Mailing Address
First Line	:	13948A WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-5359
Country	:	US
Telephone Number	:	281-496-1488
Fax Number	:	281-496-0455

Provider Business Practice Location Address
First Line	:	13948A WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-5359
Country	:	US
Telephone Number	:	281-496-1488
Fax Number	:	281-496-0455

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	ROBERT LEE THOMPSON
Credential	:	R.PH
Telephone Number	:	713-385-3364

Provider Enumeration Date	:	10/10/2013
Last Update Date	:	10/11/2013

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Directions to “THE ELIXIR PHARMACY ” Practice Location

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