=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467724328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K2PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2012
-----------------------------------------------------
Last Update Date | 02/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1348 FEDERAL RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77015-6714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-453-9103
-----------------------------------------------------
Fax | 713-453-9102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1348 FEDERAL RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77015-6714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KENNETH RAY HOPKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-453-9103
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 25747
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------