=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144565300
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUSHMED PHARMACY P.L.L.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2012
-----------------------------------------------------
Last Update Date | 02/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4430 W. FUQUA STREET, SUITE A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-582-8542
-----------------------------------------------------
Fax | 832-538-1906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4430 W. FUQUA STREET, SUITE A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-582-8542
-----------------------------------------------------
Fax | 832-538-1906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. LASHONDA CHERI RUSH
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 281-451-9447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28325
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------