=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699814962
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEO HEALTHCARE SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 02/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13415 WOODFOREST BLVD STE F
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77015-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-330-4400
-----------------------------------------------------
Fax | 713-330-4405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13415 WOODFOREST BLVD STE F
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77015-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-330-4400
-----------------------------------------------------
Fax | 713-330-4405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DELORIS THOMPSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-330-4400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 26415
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------