Healthcare Provider Details

I. General information

NPI: 1922174176
Provider Name (Legal Business Name): PHARMA SELECT TEXAS LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 WEST LOOP S SOUTH OFFICE BLDG, STE 319
HOUSTON TX
77027-9512
US

IV. Provider business mailing address

5710 LBJ FWY SUITE 325
DALLAS TX
75240-6324
US

V. Phone/Fax

Practice location:
  • Phone: 832-280-6330
  • Fax: 844-631-7599
Mailing address:
  • Phone: 214-888-8099
  • Fax: 214-261-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number29967
License Number StateTX

VIII. Authorized Official

Name: NIZAR ALIKHAN
Title or Position: CREDENTIALING CONTACT
Credential:
Phone: 214-888-8099