MEDICARE: LA RX

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	333600000X	Pharmacy	30388	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2157635	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164889788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA RX

Provider Business Mailing Address
First Line	:	589 S HAMPTON LN
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573
Country	:	US
Telephone Number	:	832-800-0190
Fax Number	:

Provider Business Practice Location Address
First Line	:	3744 BROADWAY ST STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-3046
Country	:	US
Telephone Number	:	832-426-4616
Fax Number	:	346-571-6998

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	TRINH NGUYEN
Credential	:
Telephone Number	:	832-800-0190

Provider Enumeration Date	:	01/27/2016
Last Update Date	:	07/08/2016

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Directions to “LA RX ” Practice Location

Language	Start Address	Practice Location

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