=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902277296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDURING PROVISIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2015
-----------------------------------------------------
Last Update Date | 12/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9761 FM 1960 BYPASS RD W
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77338-4067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-973-8683
-----------------------------------------------------
Fax | 281-973-8359
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14706 JULIE MEADOWS LN
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77396-4568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-722-8356
-----------------------------------------------------
Fax | 832-201-0774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. TAMIRA A PIERSON
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 832-722-8356
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 30257
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------