=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780723353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILLCROFT PLAZA PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 09/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6655 HILLCROFT ST 108
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77081-4815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-541-6655
-----------------------------------------------------
Fax | 713-541-0052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6655 HILLCROFT ST 108
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77081-4815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-541-6655
-----------------------------------------------------
Fax | 713-541-0052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING OFFICER
-----------------------------------------------------
Name | MS. WALLA A MOUSSA
-----------------------------------------------------
Credential | C.PHT.
-----------------------------------------------------
Telephone | 281-908-4541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 16233
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------