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General NPI Number Information
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NPI Number | 1013356112
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Entity Type | Organization
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Legal Business Name | MOUNTAIN CARE PHARMACY HOUSTON LLC
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 10/26/2013
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Provider Practice Location Address
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Address Line | 10665 RICHMOND AVE STE 195
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City | HOUSTON
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State | TX
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Zip | 77042-5110
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Country | US
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Telephone | 713-300-0191
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 W BELLWOOD LN
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City | SALT LAKE CITY
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State | UT
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Zip | 84123-4494
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | JARED MEMMOTT
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Credential |
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Telephone | 801-713-0106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 28722
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License Number State | TX
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