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General NPI Number Information
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NPI Number | 1801226832
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Entity Type | Organization
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Legal Business Name | BLUE MINT PHARMACY
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 9888 BISSONNET ST STE 210
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City | HOUSTON
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State | TX
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Zip | 77036-8441
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Country | US
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Telephone | 713-773-2535
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Fax |
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Provider Business Mailing Address
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Address Line | 9888 BISSONNET ST STE 210
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City | HOUSTON
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State | TX
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Zip | 77036-8441
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Country | US
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Telephone | 713-773-2535
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | TIM BLACKWELL
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Credential |
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Telephone | 713-553-1517
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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 | 28639
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License Number State | TX
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