Healthcare Provider Details

I. General information

NPI: 1760613640
Provider Name (Legal Business Name): DEERBROOK PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9816 MEMORIAL BLVD STE 105
HUMBLE TX
77338-4205
US

IV. Provider business mailing address

9816 MEMORIAL BLVD STE 105
HUMBLE TX
77338-4205
US

V. Phone/Fax

Practice location:
  • Phone: 281-446-0061
  • Fax: 281-446-1353
Mailing address:
  • Phone: 281-446-0061
  • Fax: 281-446-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number26650
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CURTIS TRAYLOR
Title or Position: OWNER
Credential: BS
Phone: 281-967-1255