Healthcare Provider Details

I. General information

NPI: 1730495961
Provider Name (Legal Business Name): ACP OF THE WOODLANDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26202 OAK RIDGE DR. STE. A-102
SPRING TX
77380-4301
US

IV. Provider business mailing address

26202 OAK RIDGE DR. STE. A-102
SPRING TX
77380-4301
US

V. Phone/Fax

Practice location:
  • Phone: 832-813-8199
  • Fax: 832-813-8949
Mailing address:
  • Phone: 832-813-8199
  • Fax: 832-813-8949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28903
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LATOSHA C ALLEN
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D
Phone: 832-813-8199