=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073061867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CLASS PHARMACIES LLC,CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2016
-----------------------------------------------------
Last Update Date | 09/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6423 RICHMOND AVE STE G
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-5926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-785-1156
-----------------------------------------------------
Fax | 713-785-1165
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11601 SHADOW CREEK PARKWAY SUITE 111, #549
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-785-1156
-----------------------------------------------------
Fax | 713-785-1165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | MS. KESHA LYNETTE HARRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-731-5727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 30998
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------