Healthcare Provider Details

I. General information

NPI: 1508826199
Provider Name (Legal Business Name): THE HOME HEALTH STORE OF TOMBALL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 HOLDERRIETH BLVD SUITE 6
TOMBALL TX
77375-4591
US

IV. Provider business mailing address

444 HOLDERRIETH BLVD SUITE 6
TOMBALL TX
77375-4591
US

V. Phone/Fax

Practice location:
  • Phone: 281-351-6216
  • Fax: 281-351-7989
Mailing address:
  • Phone: 281-351-6216
  • Fax: 281-351-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number16897
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number16897
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number16897
License Number StateTX

VIII. Authorized Official

Name: MR. THOMAS FRED GLOYER
Title or Position: CEO
Credential: RPH.
Phone: 281-351-6216