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General NPI Number Information
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NPI Number | 1134627938
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Entity Type | Organization
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Legal Business Name | MIRACLE PHARMACY INC.
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 15825 BELLAIRE BLVD STE E
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City | HOUSTON
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State | TX
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Zip | 77083-2353
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Country | US
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Telephone | 281-809-5707
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Fax | 281-809-5703
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Provider Business Mailing Address
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Address Line | 19819 REDWOOD TREE ST
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City | RICHMOND
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State | TX
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Zip | 77407-7113
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Country | US
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Telephone | 713-614-7397
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | ANTHONY IGBOKWE
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Credential |
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Telephone | 713-614-7397
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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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