=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083951800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL CARE CAC PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2013
-----------------------------------------------------
Last Update Date | 01/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14755 NORTH FWY STE 200
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77090-6503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-377-8137
-----------------------------------------------------
Fax | 281-875-9619
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14755 NORTH FREEWAY, SUITE 200
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-377-8137
-----------------------------------------------------
Fax | 281-875-9619
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | AUGUSTINE NJOKU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-872-4177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28236
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------