Healthcare Provider Details

I. General information

NPI: 1487630984
Provider Name (Legal Business Name): LEVIANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21700 KINGSLAND BLVD STE 105
KATY TX
77450-2546
US

IV. Provider business mailing address

PO BOX 1197
BRENHAM TX
77834-1197
US

V. Phone/Fax

Practice location:
  • Phone: 281-829-6497
  • Fax: 281-829-3581
Mailing address:
  • Phone: 281-829-6497
  • Fax: 281-829-5381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number24068
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number24068
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number24068
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number24068
License Number StateTX

VIII. Authorized Official

Name: DISEIYE IYEBOTE
Title or Position: OWNER
Credential: MD
Phone: 281-829-6497