=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558985515
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH GURU RX CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2020
-----------------------------------------------------
Last Update Date | 06/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107A EAST ST
-----------------------------------------------------
City | HUTTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78634-4323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-846-6002
-----------------------------------------------------
Fax | 512-846-9499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107A EAST ST
-----------------------------------------------------
City | HUTTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78634-4323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-846-6002
-----------------------------------------------------
Fax | 512-846-9499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MOHAMED SAJID SHAIKH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-846-6002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------