MEDICARE: PERSONALMED

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	31744	TX

General Provider Information

NPI Number	:	1134626997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONALMED

Provider Business Mailing Address
First Line	:	10370 RICHMOND AVE STE 230
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-4141
Country	:	US
Telephone Number	:	281-776-3854
Fax Number	:

Provider Business Practice Location Address
First Line	:	10370 RICHMOND AVE STE 230
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-4141
Country	:	US
Telephone Number	:	281-776-3854
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY NETWORK MANAGER
Name	:	URSULA C HENRY
Credential	:
Telephone Number	:	281-776-3854

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/09/2018

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Directions to “PERSONALMED ” Practice Location

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