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General NPI Number Information
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NPI Number | 1750541371
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Entity Type | Organization
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Legal Business Name | HOLIDAY RX INC
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 9315 KIRBY DR SUITE B
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City | HOUSTON
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State | TX
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Zip | 77054-2516
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Country | US
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Telephone | 713-791-9290
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Fax |
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Provider Business Mailing Address
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Address Line | 4143 VIA MARINA #819
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5303
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Country | US
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Telephone |
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Fax | 310-574-4515
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Authorized Official
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Title or Position | PRESIDENT OF OPERATIONS
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Name | MR. JARED NEWBERRY
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Credential |
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Telephone | 612-462-0602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 25494
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License Number State | TX
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