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General NPI Number Information
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NPI Number | 1346476470
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Entity Type | Organization
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Legal Business Name | FOUNTAINVIEW PHARMACY
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 3013 FOUNTAINVIEW SUITE #A
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City | HOUSTON
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State | TX
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Zip | 77057-6137
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Country | US
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Telephone | 713-784-2112
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Fax | 713-784-4310
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Provider Business Mailing Address
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Address Line | 3013 FOUNTAIN VIEW DR STE A
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City | HOUSTON
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State | TX
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Zip | 77057-6132
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Country | US
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Telephone | 713-784-2112
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Fax | 713-784-4310
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Authorized Official
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Title or Position | MANAGER
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Name | RUBEN E. DAVIS
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Credential |
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Telephone | 713-784-2112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 26431
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License Number State | TX
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