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General NPI Number Information
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NPI Number | 1811385727
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Entity Type | Organization
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Legal Business Name | MILLENNIUM PHYSICIANS ASSOCIATION PLLC
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 22710 PROFESSIONAL DR STE 110
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City | KINGWOOD
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State | TX
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Zip | 77339-6009
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Country | US
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Telephone | 281-312-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 22710 PROFESSIONAL DR STE 100
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City | KINGWOOD
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State | TX
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Zip | 77339-6009
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Country | US
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Telephone | 281-298-1129
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Fax |
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | DR. DEL INGRAM
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Credential | PHARMD, RPH
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Telephone | 281-312-8585
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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 | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 29708
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License Number State | TX
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