=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841788874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDI BROTHERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2018
-----------------------------------------------------
Last Update Date | 02/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9820 GULF FWY STE A10
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77034-1057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-272-6503
-----------------------------------------------------
Fax | 281-272-6504
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1163
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77487-1163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-272-6503
-----------------------------------------------------
Fax | 281-272-6504
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | HENRY NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-461-5131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 31951
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------