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General NPI Number Information
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NPI Number | 1366956062
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Entity Type | Organization
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Legal Business Name | MEDLINE PHARMACY OF KATY LLC
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 3616 FRY ROAD SUITE 220
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City | KATY
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State | TX
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Zip | 77449
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Country | US
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Telephone | 832-391-6108
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Fax | 832-321-3261
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Provider Business Mailing Address
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Address Line | 3616 FRY ROAD SUITE 220
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City | KATY
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State | TX
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Zip | 77449
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Country | US
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Telephone | 832-391-6108
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Fax | 832-321-3261
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Authorized Official
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Title or Position | OWNER
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Name | ALVIN ELLIOT
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Credential |
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Telephone | 281-799-2823
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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 | 31894
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License Number State | TX
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