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General NPI Number Information
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NPI Number | 1699732487
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Entity Type | Organization
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Legal Business Name | MEDICINE MAN, L.P.
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 131 E HOSPITAL DR
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City | ANGLETON
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State | TX
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Zip | 77515-4111
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Country | US
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Telephone | 979-849-4353
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Fax | 979-849-4762
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Provider Business Mailing Address
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Address Line | 16250 DALLAS PKWY SUITE 100
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City | DALLAS
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State | TX
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Zip | 75248-2626
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Country | US
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Telephone | 972-860-0202
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Fax | 972-860-0298
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | ERNEST H. ZOST
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Credential | RPH
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Telephone | 972-860-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 20996
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License Number State | TX
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