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General NPI Number Information
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NPI Number | 1710256045
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Entity Type | Organization
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Legal Business Name | TEXAS VERVE ENTERPRISES
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 3517 N MAIN ST SUITE 1
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City | BAYTOWN
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State | TX
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Zip | 77521-4117
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Country | US
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Telephone | 281-838-8025
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Fax | 281-838-8461
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Provider Business Mailing Address
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Address Line | 3517 N MAIN ST
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City | BAYTOWN
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State | TX
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Zip | 77521-4117
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Country | US
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Telephone | 281-838-8025
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Fax | 281-838-8461
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | JADA GILBERT
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Credential |
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Telephone | 281-935-3109
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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 | 27706
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License Number State | TX
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