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General NPI Number Information
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NPI Number | 1225022197
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Entity Type | Organization
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Legal Business Name | SOUTHBELT PHARMACY
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11914 ASTORIA BLVD SUITE 190
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City | HOUSTON
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State | TX
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Zip | 77089-6064
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Country | US
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Telephone | 713-610-9145
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Fax | 713-610-9140
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Provider Business Mailing Address
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Address Line | 11914 ASTORIA BLVD SUITE 190
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City | HOUSTON
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State | TX
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Zip | 77089-6064
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Country | US
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Telephone | 713-610-9145
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Fax | 713-610-9140
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RAYMOND M MEDRANO
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Credential | RPH
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Telephone | 713-610-9145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 11860
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License Number State | TX
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