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General NPI Number Information
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NPI Number | 1639580418
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Entity Type | Organization
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Legal Business Name | 360 PHARMACY SERVICES LLC
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 100 E NASA RD 1 SUITE 101
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City | WEBSTER
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State | TX
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Zip | 77598-5346
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Country | US
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Telephone | 281-557-1700
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Fax | 281-557-8900
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Provider Business Mailing Address
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Address Line | 100 E NASA RD 1 SUITE 101
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City | WEBSTER
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State | TX
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Zip | 77598-5346
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Country | US
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Telephone | 281-557-1700
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Fax | 281-557-8900
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JEFF COCKERELL
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Credential |
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Telephone | 281-557-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 29268
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License Number State | TX
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