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General NPI Number Information
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NPI Number | 1831687508
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Entity Type | Organization
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Legal Business Name | THEIA PHARMACY
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 12450 EAST FWY STE 110
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City | HOUSTON
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State | TX
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Zip | 77015-5527
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Country | US
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Telephone | 713-504-4511
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Fax | 832-491-0728
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Provider Business Mailing Address
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Address Line | 1625 MAIN ST APT 1815
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City | HOUSTON
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State | TX
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Zip | 77002-7546
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Country | US
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Telephone | 713-504-4511
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | ANDRE DURUEWURU
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Credential |
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Telephone | 713-504-4511
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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 | 31678
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License Number State | TX
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