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General NPI Number Information
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NPI Number | 1346418837
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Entity Type | Organization
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Legal Business Name | MAIN STREET PHARMACY INC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 12361 MAIN ST
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City | HOUSTON
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State | TX
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Zip | 77035-6200
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Country | US
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Telephone | 713-729-3800
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Fax | 713-729-3837
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Provider Business Mailing Address
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Address Line | 5611 TALLOW LN
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City | HOUSTON
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State | TX
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Zip | 77021-3216
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Country | US
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Telephone | 713-747-6116
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Fax | 713-741-8429
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Authorized Official
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Title or Position | PHRMD
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Name | JW LIGON
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Credential | RPH
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Telephone | 713-747-6116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 25848
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License Number State | TX
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