=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629138490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 10/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6630 SOUTHWEST FWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-2210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-266-5425
-----------------------------------------------------
Fax | 713-266-6506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6630 SOUTHWEST FWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-2210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-266-5425
-----------------------------------------------------
Fax | 713-266-6506
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST-IN-CHARGE
-----------------------------------------------------
Name | VICTOR A EHIEMUA
-----------------------------------------------------
Credential | R.PH
-----------------------------------------------------
Telephone | 713-266-5425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number | 12275
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 12275
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------