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General NPI Number Information
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NPI Number | 1720193766
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Entity Type | Organization
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Legal Business Name | RAPHA PHARMACY
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 12600 BISSONNET ST STE E1
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City | HOUSTON
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State | TX
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Zip | 77099-1395
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Country | US
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Telephone | 832-328-1855
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Fax | 832-328-1845
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Provider Business Mailing Address
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Address Line | 12600 BISSONNET ST STE E1
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City | HOUSTON
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State | TX
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Zip | 77099-1395
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Country | US
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Telephone | 832-328-1855
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Fax | 832-328-1845
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Authorized Official
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Title or Position | DIR OF PHRMCY
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Name | PAMELA FOMUNUNG
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Credential |
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Telephone | 832-328-1855
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 21402
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License Number State | TX
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