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General NPI Number Information
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NPI Number | 1487263091
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Entity Type | Organization
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Legal Business Name | EXPERIENCE INFUSION CENTER-KATY-INC
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 25910 WESTHEIMER PKWY STE 110
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City | KATY
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State | TX
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Zip | 77494-5391
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Country | US
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Telephone | 281-240-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 25910 WESTHEIMER PKWY STE 110
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City | KATY
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State | TX
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Zip | 77494-5391
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANGELA MACKEY-MITCHELL
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Credential |
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Telephone | 281-240-4144
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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 |
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License Number State |
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