Healthcare Provider Details

I. General information

NPI: 1033411996
Provider Name (Legal Business Name): PDPG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18720 STATE HIGHWAY 249 STE A
HOUSTON TX
77070-4297
US

IV. Provider business mailing address

18720 STATE HIGHWAY 249 STE A
HOUSTON TX
77070-4297
US

V. Phone/Fax

Practice location:
  • Phone: 281-894-3103
  • Fax: 281-894-3102
Mailing address:
  • Phone: 281-894-3103
  • Fax: 281-894-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number27265
License Number StateTX

VIII. Authorized Official

Name: DEMETHRA ORION
Title or Position: OWNER/MANAGER
Credential:
Phone: 281-894-3103