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General NPI Number Information
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NPI Number | 1730432329
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Entity Type | Organization
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Legal Business Name | ECLECTIC RX CONSULTING, INC.
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 2000 CRAWFORD ST STE 105
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City | HOUSTON
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State | TX
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Zip | 77002-9071
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Country | US
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Telephone | 346-980-5828
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Fax | 346-980-5942
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Provider Business Mailing Address
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Address Line | 2000 CRAWFORD ST STE 105
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City | HOUSTON
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State | TX
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Zip | 77002-9071
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Country | US
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Telephone | 346-980-5828
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Fax | 346-980-5942
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Authorized Official
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Title or Position | OWNER
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Name | SHALANDRIA RENEE SIMPSON
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Credential |
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Telephone | 346-980-5828
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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 | 31074
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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