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General NPI Number Information
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NPI Number | 1851333207
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Entity Type | Organization
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Legal Business Name | MAURICEVILLE PHARMACY LLC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 10897 HWY 12
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City | MAURICEVILLE
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State | TX
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Zip | 77626
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Country | US
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Telephone | 409-745-3784
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Fax | 409-745-5910
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Provider Business Mailing Address
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Address Line | PO BOX 1149
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City | MAURICEVILLE
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State | TX
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Zip | 77626-1149
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Country | US
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Telephone | 409-745-3784
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Fax | 409-745-5910
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Authorized Official
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Title or Position | MANAGER
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Name | TREY HANEY
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Credential |
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Telephone | 409-769-2406
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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 | 23916
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License Number State | TX
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