MEDICARE: MEDRICK MORRIS

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	26906	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5900267	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1053632745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDRICK MORRIS

Provider Business Mailing Address
First Line	:	5702 MINDEN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-3031
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10701 W BELLFORT ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4748
Country	:	US
Telephone Number	:	281-988-0880
Fax Number	:	281-988-0882

Authorized Official
Title or Position	:	OWNER
Name	:	MEDRICK MORRIS
Credential	:
Telephone Number	:	281-988-0880

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	06/16/2010

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Directions to “MEDRICK MORRIS ” Practice Location

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