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General NPI Number Information
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NPI Number | 1629193800
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Entity Type | Organization
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Legal Business Name | MEMORIAL CITY PROFESSIONAL PHARMACY
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 915 GESSNER RD NO 200
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City | HOUSTON
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State | TX
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Zip | 77024-2527
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Country | US
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Telephone | 713-461-7171
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Fax | 713-461-7070
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Provider Business Mailing Address
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Address Line | 915 GESSNER RD NO 200
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City | HOUSTON
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State | TX
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Zip | 77024-2527
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND MANAGER
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Name | G M NADDAF
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Credential |
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Telephone | 713-461-7171
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 24199
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License Number State | TX
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