Healthcare Provider Details

I. General information

NPI: 1144657206
Provider Name (Legal Business Name): ASTRO RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20423 KUYKENDAHL RD SUITE 250
SPRING TX
77379-3322
US

IV. Provider business mailing address

20423 KUYKENDAHL RD SUITE 250
SPRING TX
77379-3322
US

V. Phone/Fax

Practice location:
  • Phone: 832-209-4999
  • Fax: 832-559-7213
Mailing address:
  • Phone: 832-209-4999
  • Fax: 832-559-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number31022
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number31022
License Number StateTX

VIII. Authorized Official

Name: MISS STACY COPLEN
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 850-502-2449