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General NPI Number Information
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NPI Number | 1275108227
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Entity Type | Organization
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Legal Business Name | WELLCARE OF HOUSTON GROUP, LLC
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 02/06/2022
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Provider Practice Location Address
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Address Line | 14343 TORREY CHASE BLVD STE I
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City | HOUSTON
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State | TX
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Zip | 77014-1630
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Country | US
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Telephone | 408-661-3881
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Fax |
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Provider Business Mailing Address
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Address Line | 17515 SPRING CYPRESS RD # 256
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City | CYPRESS
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State | TX
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Zip | 77429-2688
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Country | US
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Telephone | 408-661-3881
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGED
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Name | MR. BRYAN T PHAN
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Credential | RPH
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Telephone | 408-661-3881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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