=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144669094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANTRA INVESTMENTS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2013
-----------------------------------------------------
Last Update Date | 06/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5537 LAWNDALE ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77023-3837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-514-8028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6315 COOL WATER DR
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77479-5530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-565-5921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. LIZYAMMA A BOSE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-565-5921
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 28578
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------