Healthcare Provider Details

I. General information

NPI: 1851682033
Provider Name (Legal Business Name): PCP PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 FAIRMONT PKWY STE A
PASADENA TX
77505-3756
US

IV. Provider business mailing address

5108 FAIRMONT PKWY STE A
PASADENA TX
77505-3756
US

V. Phone/Fax

Practice location:
  • Phone: 281-991-1300
  • Fax:
Mailing address:
  • Phone: 281-991-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number27443
License Number StateTX

VIII. Authorized Official

Name: MRS. CYNTHIA DENISE NOWLIN
Title or Position: MANAGER
Credential:
Phone: 281-991-1300