Healthcare Provider Details

I. General information

NPI: 1275892549
Provider Name (Legal Business Name): LINZAY KELLY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 W SAM HOUSTON PKWY N STE 170
HOUSTON TX
77041-5191
US

IV. Provider business mailing address

5353 W SAM HOUSTON PKWY N STE 170
HOUSTON TX
77041-5191
US

V. Phone/Fax

Practice location:
  • Phone: 281-619-2050
  • Fax: 866-300-9797
Mailing address:
  • Phone: 281-619-2050
  • Fax: 866-300-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33365
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: