Healthcare Provider Details

I. General information

NPI: 1659853422
Provider Name (Legal Business Name): HARVEST PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9740 BARKER CYPRESS RD STE 107
CYPRESS TX
77433-1974
US

IV. Provider business mailing address

9740 BARKER CYPRESS RD STE 107
CYPRESS TX
77433-1974
US

V. Phone/Fax

Practice location:
  • Phone: 281-685-7279
  • Fax:
Mailing address:
  • Phone: 281-685-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHARLES MATTHEW VO
Title or Position: MANAGING MEMBER
Credential: PHARMD
Phone: 281-685-7279