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General NPI Number Information
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NPI Number | 1669414231
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Entity Type | Organization
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Legal Business Name | PEP NIC & MIC LLC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 8449 W BELLFORT ST STE 130
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City | HOUSTON
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State | TX
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Zip | 77071-2245
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Country | US
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Telephone | 713-771-1767
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Fax | 713-771-1768
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Provider Business Mailing Address
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Address Line | 8204 ELMBROOK DR SUITE 176
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City | DALLAS
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State | TX
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Zip | 75247-4067
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Country | US
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Telephone | 713-771-1767
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Fax | 713-771-1768
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Authorized Official
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Title or Position | MANAGER
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Name | PHILIP PARKER
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Credential |
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Telephone | 713-771-1767
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 24365
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License Number State | TX
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