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General NPI Number Information
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NPI Number | 1508846056
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Entity Type | Organization
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Legal Business Name | FOREST LAKE PHARMACY
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 9129 MESA DR
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City | HOUSTON
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State | TX
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Zip | 77028-1606
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Country | US
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Telephone | 713-635-1441
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Fax | 713-635-6810
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Provider Business Mailing Address
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Address Line | 9129 MESA DR
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City | HOUSTON
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State | TX
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Zip | 77028-1606
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Country | US
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Telephone | 713-635-1441
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Fax | 713-635-6810
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | MR. FRANCIS CHAN
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Credential | R.PH.
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Telephone | 713-635-1441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 11495
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License Number State | TX
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