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General NPI Number Information
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NPI Number | 1700245503
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Entity Type | Organization
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Legal Business Name | IDEAL PHARMACY
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 2904 FULTON ST STE A
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City | HOUSTON
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State | TX
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Zip | 77009-5792
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Country | US
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Telephone | 832-834-7463
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Fax | 832-834-7457
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Provider Business Mailing Address
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Address Line | 24601 HOSFORD MEADOWS DR
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City | PORTER
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State | TX
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Zip | 77365-3083
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Country | US
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Telephone | 832-834-7463
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Fax | 832-834-7457
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | ALEX JAMES DEAL
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Credential | RPH
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Telephone | 281-728-9761
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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 | 30635
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License Number State | TX
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