Healthcare Provider Details

I. General information

NPI: 1245386689
Provider Name (Legal Business Name): SOUTHERN TIER INFUSION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/07/2023
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8687 LOUETTA RD STE 150
SPRING TX
77379-6672
US

IV. Provider business mailing address

2535 JOHNS PL
JAMESTOWN NY
14701-9210
US

V. Phone/Fax

Practice location:
  • Phone: 281-251-0888
  • Fax: 716-708-6248
Mailing address:
  • Phone: 716-720-5121
  • Fax: 716-708-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RICHARD B MOON
Title or Position: OWNER PHARMACIST
Credential: PHARMD
Phone: 716-720-5121