=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427628395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TU FARMACIALLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2021
-----------------------------------------------------
Last Update Date | 07/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5220 AIRLINE DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77022-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-614-1693
-----------------------------------------------------
Fax | 713-485-6926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5220 AIRLINE DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77022-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-614-1693
-----------------------------------------------------
Fax | 713-485-6926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING OFFICER
-----------------------------------------------------
Name | GLORIA OCHOA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-485-6920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------