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General NPI Number Information
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NPI Number | 1154608933
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Entity Type | Organization
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Legal Business Name | 1960 FAMILY PRACTICE PA
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 837 CYPRESS CREEK PKWY STE 105A
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City | HOUSTON
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State | TX
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Zip | 77090-3422
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Country | US
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Telephone | 281-453-7205
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Fax | 281-453-7242
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Provider Business Mailing Address
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Address Line | 20320 NORTHWEST FWY STE 900
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City | JERSEY VILLAGE
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State | TX
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Zip | 77065-5620
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Country | US
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Telephone | 281-453-7918
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Fax | 281-453-7242
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Authorized Official
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Title or Position | PIC
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Name | MARCIA SMITH
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Credential |
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Telephone | 281-453-7205
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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 | 27730
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License Number State | TX
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