MEDICARE: PRANAMI LLC

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
2	3336C0004X	Compounding Pharmacy
3	333600000X	Pharmacy	31681	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2176239	OTHER		PK

General Provider Information

NPI Number	:	1033611801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRANAMI LLC

Provider Business Mailing Address
First Line	:	2532 FONDREN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-2308
Country	:	US
Telephone Number	:	713-782-6212
Fax Number	:	713-782-2001

Provider Business Practice Location Address
First Line	:	2532 FONDREN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-2308
Country	:	US
Telephone Number	:	713-782-6212
Fax Number	:	713-782-2001

Authorized Official
Title or Position	:	MANAGER
Name	:	PRITI PATEL
Credential	:
Telephone Number	:	713-408-8062

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/07/2018

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Directions to “PRANAMI LLC ” Practice Location

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