Healthcare Provider Details

I. General information

NPI: 1508908112
Provider Name (Legal Business Name): INTRACARE COMMUNITY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 CYPRESS STATION DR STE 110
HOUSTON TX
77090-3002
US

IV. Provider business mailing address

1120 CYPRESS STATION DR STE 110
HOUSTON TX
77090-3002
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-7821
  • Fax: 713-790-1620
Mailing address:
  • Phone: 713-790-7821
  • Fax: 713-790-1620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number25424
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TERRY SCOVILL
Title or Position: CEO
Credential: PHARM D
Phone: 713-790-0949