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General NPI Number Information
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NPI Number | 1215393376
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Entity Type | Organization
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Legal Business Name | PRIMESOURCE RX LLC
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 2656 S LOOP W STE 574
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City | HOUSTON
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State | TX
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Zip | 77054-2664
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Country | US
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Telephone | 832-464-7616
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Fax |
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Provider Business Mailing Address
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Address Line | 2656 S LOOP W STE 574
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City | HOUSTON
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State | TX
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Zip | 77054-2664
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Country | US
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Telephone | 832-464-7616
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | JOHN TRUONG
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Credential |
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Telephone | 832-464-7616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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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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