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General NPI Number Information
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NPI Number | 1073858288
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Entity Type | Organization
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Legal Business Name | HAZEL'S COMPUNDING RX PHARMACY
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 2404 SMITH RANCH RD SUITE 100
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City | PEARLAND
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State | TX
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Zip | 77584
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Country | US
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Telephone | 713-340-0202
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Fax | 713-340-0203
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Provider Business Mailing Address
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Address Line | 2404 SMITH RANCH RD SUITE #100
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City | PEARLAND
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State | TX
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Zip | 77584
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Country | US
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Telephone | 713-340-0202
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Fax | 713-340-0203
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Authorized Official
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Title or Position | MANAGING OFFICER
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Name | DR. TRACEY BENSON
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Credential | PHARM.D.
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Telephone | 832-264-7632
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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 | 28357
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License Number State | TX
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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 | 28357
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License Number State | TX
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