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General NPI Number Information
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NPI Number | 1811405210
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Entity Type | Organization
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Legal Business Name | MTM PHARMACY, LLC
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 18918 FM 529 RD UNIT 5
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City | CYPRESS
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State | TX
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Zip | 77433-3373
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Country | US
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Telephone | 504-858-5733
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Fax |
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Provider Business Mailing Address
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Address Line | 12818 DOVE POINT LN
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City | HOUSTON
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State | TX
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Zip | 77041-4256
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Country | US
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Telephone | 504-858-5733
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MINH NGUYEN
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Credential | RPH
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Telephone | 504-858-5733
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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 |
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License Number State | TX
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