Healthcare Provider Details

I. General information

NPI: 1205062445
Provider Name (Legal Business Name): AZTEC RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6243 FAIRMONT PKWY STE 206
PASADENA TX
77505-4047
US

IV. Provider business mailing address

6243 FAIRMONT PKWY STE 206
PASADENA TX
77505-4045
US

V. Phone/Fax

Practice location:
  • Phone: 281-998-1100
  • Fax: 281-998-1104
Mailing address:
  • Phone: 281-998-1100
  • Fax: 281-998-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number26490
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GEORGE BALANDRAN
Title or Position: PHARMACIST-IN-CHARGE
Credential:
Phone: 832-607-7452