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General NPI Number Information
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NPI Number | 1033412366
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Entity Type | Organization
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Legal Business Name | PRICELINE PHARMACY
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 8603 BROADWAY ST STE 107
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City | PEARLAND
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State | TX
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Zip | 77584-8172
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Country | US
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Telephone | 281-485-7777
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Fax | 281-485-7784
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Provider Business Mailing Address
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Address Line | 8603 BROADWAY ST STE 107
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City | PEARLAND
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State | TX
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Zip | 77584-8172
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Country | US
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Telephone | 281-485-7777
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Fax | 281-485-7784
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | KENNETH YAAFI
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Credential |
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Telephone | 281-904-2552
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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 | 27262
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License Number State | TX
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