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General NPI Number Information
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NPI Number | 1538125042
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Entity Type | Organization
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Legal Business Name | MEDICINE MAN, L.P.
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1212 S GORDON ST
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City | ALVIN
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State | TX
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Zip | 77511-3445
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Country | US
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Telephone | 281-331-4409
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Fax | 281-331-7770
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Provider Business Mailing Address
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Address Line | 16250 DALLAS PKWY SUITE 100
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City | DALLAS
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State | TX
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Zip | 75248-2626
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Country | US
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Telephone | 972-860-0202
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Fax | 972-860-0298
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | ERNEST H. ZOST
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Credential | RPH
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Telephone | 972-860-0202
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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 | 20995
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License Number State | TX
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