Healthcare Provider Details

I. General information

NPI: 1265897664
Provider Name (Legal Business Name): MILLENNIUM RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12560 REED RD STE 350
SUGAR LAND TX
77478-3380
US

IV. Provider business mailing address

12560 REED RD STE 350
SUGAR LAND TX
77478-3380
US

V. Phone/Fax

Practice location:
  • Phone: 855-346-7600
  • Fax: 855-346-7800
Mailing address:
  • Phone: 855-346-7600
  • Fax: 855-346-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number30403
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VALORIE GINGRICH
Title or Position: VP PHARMACY SERVICES
Credential:
Phone: 855-346-7600