=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437820586
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOICE PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2021
-----------------------------------------------------
Last Update Date | 09/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9935 BISSONNET ST UNIT B
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-778-0463
-----------------------------------------------------
Fax | 713-778-0573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9935 BISSONNET ST UNIT B
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-778-0463
-----------------------------------------------------
Fax | 713-778-0573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | GLORY UZUNMA NOSIKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-778-0463
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------