Healthcare Provider Details

I. General information

NPI: 1245543909
Provider Name (Legal Business Name): SRB PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12707 TRINITY ST SUITE 177
STAFFORD TX
77477-4212
US

IV. Provider business mailing address

12707 TRINITY ST SUITE 177
STAFFORD TX
77477-4212
US

V. Phone/Fax

Practice location:
  • Phone: 281-240-3308
  • Fax: 281-240-3308
Mailing address:
  • Phone: 281-240-3308
  • Fax: 281-240-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. LES PIENIAZEK
Title or Position: PHARMACIST-IN-CHARGE
Credential: RPH
Phone: 281-240-3308