Healthcare Provider Details

I. General information

NPI: 1124562962
Provider Name (Legal Business Name): COLDSPRINGS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 STATE HIGHWAY 150 W
COLDSPRING TX
77331-4025
US

IV. Provider business mailing address

15100 STATE HIGHWAY 150 W
COLDSPRING TX
77331-4025
US

V. Phone/Fax

Practice location:
  • Phone: 936-653-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: JASMEET SINGH
Title or Position: MANAGER
Credential:
Phone: 832-859-9523