Healthcare Provider Details

I. General information

NPI: 1881192185
Provider Name (Legal Business Name): PHARM HOUSE NEEDVILLE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 06/10/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 HIGHWAY 36 STE 118B
NEEDVILLE TX
77461-8487
US

IV. Provider business mailing address

PO BOX 1030
NEEDVILLE TX
77461-1030
US

V. Phone/Fax

Practice location:
  • Phone: 979-793-5534
  • Fax: 979-793-5534
Mailing address:
  • Phone: 979-793-5534
  • Fax: 979-793-5654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VALORIE GINGRICH
Title or Position: DELEGATED OFFICIAL
Credential: RPH
Phone: 281-772-1568