MEDICARE: LOCKWOOD PROFESSIONAL BLDG PHCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	22853	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4501145	OTHER	OTHER ID NUMBER

General Provider Information

NPI Number	:	1023195997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOCKWOOD PROFESSIONAL BLDG PHCY

Provider Business Mailing Address
First Line	:	4315 LOCKWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-4117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 LOCKWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-4117
Country	:	US
Telephone Number	:	713-672-2262
Fax Number	:	713-671-9941

Authorized Official
Title or Position	:	OPER MANG
Name	:	FREDDIE BROWN
Credential	:
Telephone Number	:	832-277-1503

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/10/2008

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