Healthcare Provider Details

I. General information

NPI: 1659820108
Provider Name (Legal Business Name): LIGHTHOUSE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 SPRING CYPRESS RD
SPRING TX
77379-3138
US

IV. Provider business mailing address

8955 SPRING CYPRESS RD
SPRING TX
77379-3138
US

V. Phone/Fax

Practice location:
  • Phone: 832-422-3604
  • Fax: 832-534-8296
Mailing address:
  • Phone: 832-422-3604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEVIN HAI NGUYEN
Title or Position: PRESIDENT
Credential:
Phone: 713-854-6105