=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225235211
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAPHA RESOURCES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8449 W BELLFORT ST SUITE# 310
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77071-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-776-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8449 W BELLFORT ST SUITE# 310
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77071-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-776-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | PAM FOMUNUNG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-355-4488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 25602
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------