Healthcare Provider Details

I. General information

NPI: 1437740370
Provider Name (Legal Business Name): PHOUANGKHAM SOUMPHOLPHAKDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 LOUETTA RD
SPRING TX
77379-7234
US

IV. Provider business mailing address

7310 LOUETTA RD
SPRING TX
77379-7234
US

V. Phone/Fax

Practice location:
  • Phone: 281-251-0255
  • Fax: 866-609-7042
Mailing address:
  • Phone: 281-251-0255
  • Fax: 866-609-7042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number148010
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: