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General NPI Number Information
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NPI Number | 1801900790
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Entity Type | Organization
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Legal Business Name | WAYSIDE PHARMACY INC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 7109 B LAWNDALE AND 75TH
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City | HOUSTON
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State | TX
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Zip | 77023-4244
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Country | US
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Telephone | 713-928-5410
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Fax |
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Provider Business Mailing Address
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Address Line | 7109 B LAWNDALE AND 75TH
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City | HOUSTON
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State | TX
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Zip | 77023-4244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | MANUEL CAUDILLO
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Credential |
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Telephone | 713-928-5410
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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 | 11705
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License Number State | TX
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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 |
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License Number State |
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