Healthcare Provider Details

I. General information

NPI: 1417738774
Provider Name (Legal Business Name): AMY CO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5251 FM 2920 RD
SPRING TX
77388-3004
US

IV. Provider business mailing address

646 S FLORES ST
SAN ANTONIO TX
78204-1219
US

V. Phone/Fax

Practice location:
  • Phone: 281-353-2982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73319
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: