=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659770048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMMONS PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2014
-----------------------------------------------------
Last Update Date | 02/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9555 W SAM HOUSTON PKWY S STE 180
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77099-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-582-8758
-----------------------------------------------------
Fax | 832-582-8797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9555 W SAM HOUSTON PKWY S SUITE 180
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77099-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-582-8758
-----------------------------------------------------
Fax | 832-582-8797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MBEI ENOH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-582-8758
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 29442
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------