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General NPI Number Information
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NPI Number | 1902913213
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Entity Type | Organization
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Legal Business Name | MANGUM ROAD PHARMACY, INC.
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2855 MANGUM RD STE 109
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City | HOUSTON
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State | TX
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Zip | 77092-7498
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Country | US
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Telephone | 713-682-6565
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Fax | 713-682-6572
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Provider Business Mailing Address
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Address Line | 2855 MANGUM RD STE 109
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City | HOUSTON
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State | TX
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Zip | 77092-7498
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Country | US
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Telephone | 713-682-6565
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Fax | 713-682-6572
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Authorized Official
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Title or Position | CORP PRESIDENT
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Name | KIMBERLY R HOWARD
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Credential | RN
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Telephone | 713-682-6565
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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 | 25021
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License Number State | TX
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