=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487630984
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEVIANT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2005
-----------------------------------------------------
Last Update Date | 05/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21700 KINGSLAND BLVD STE 105
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-2546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-829-6497
-----------------------------------------------------
Fax | 281-829-3581
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1197
-----------------------------------------------------
City | BRENHAM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77834-1197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-829-6497
-----------------------------------------------------
Fax | 281-829-5381
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SEUN RAPHEAL OLUWO
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 281-829-6497
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 24068
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 24068
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number | 24068
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 24068
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------