=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245631613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIN RX 807, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2014
-----------------------------------------------------
Last Update Date | 04/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15271 SOUTHWEST FREEWAY
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-955-5700
-----------------------------------------------------
Fax | 713-955-6970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15271 SOUTHWEST FREEWAY
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-955-5700
-----------------------------------------------------
Fax | 713-955-6970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CHRISTINA GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-928-9168
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 29476
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------