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General NPI Number Information
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NPI Number | 1780995084
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Entity Type | Organization
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Legal Business Name | PRESTIGE PHARMACY INC
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 6550 MAPLERIDGE ST SUITE 116
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City | HOUSTON
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State | TX
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Zip | 77081-4600
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Country | US
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Telephone | 832-778-6552
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Fax | 832-778-6550
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Provider Business Mailing Address
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Address Line | 6550 MAPLERIDGE ST SUITE 116
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City | HOUSTON
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State | TX
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Zip | 77081-4600
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Country | US
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Telephone | 832-778-6552
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Fax | 832-778-6550
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Authorized Official
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Title or Position | PHARM/OWNER
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Name | AMANUEL GHEBREMICHAEL
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Credential |
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Telephone | 832-778-6652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 24959
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License Number State | TX
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