=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285080085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POST OAK PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2016
-----------------------------------------------------
Last Update Date | 05/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 W DALLAS ST
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77301-2234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-578-4888
-----------------------------------------------------
Fax | 866-976-9043
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 W DALLAS ST
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77301-2234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-578-4888
-----------------------------------------------------
Fax | 866-976-9043
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. VINCENT CARTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 866-578-4888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------