Healthcare Provider Details

I. General information

NPI: 1326869728
Provider Name (Legal Business Name): PROSPER COMPOUNDING PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 HIGHWAY 6 STE 250A
SUGAR LAND TX
77478-4523
US

IV. Provider business mailing address

3527 HIGHWAY 6 STE 250
SUGAR LAND TX
77478-4523
US

V. Phone/Fax

Practice location:
  • Phone: 281-302-5454
  • Fax: 281-302-5583
Mailing address:
  • Phone: 281-302-5454
  • Fax: 281-302-5583

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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: UZOAMAKA BALONWU
Title or Position: PRESIDENT
Credential:
Phone: 832-236-5852