=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235859638
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUKTI HEALTH SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2022
-----------------------------------------------------
Last Update Date | 08/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11301 FALLBROOK DRIVE SUITE 124
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-653-9300
-----------------------------------------------------
Fax | 281-653-9347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11301 FALLBROOK DRIVE SUITE 124
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-653-9300
-----------------------------------------------------
Fax | 281-653-9347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. NITIN JAIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-540-0150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------