MEDICARE: FARMACIA ETC 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	25940	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2144763	OTHER		PK

General Provider Information

NPI Number	:	1174796189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACIA ETC LLC

Provider Business Mailing Address
First Line	:	6430 HILLCROFT ST STE 100B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-3191
Country	:	US
Telephone Number	:	713-771-0061
Fax Number	:	713-771-0065

Provider Business Practice Location Address
First Line	:	6430 HILLCROFT ST STE 100B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-3191
Country	:	US
Telephone Number	:	713-771-0061
Fax Number	:	713-771-0065

Authorized Official
Title or Position	:	PHARMACY OWNER,AO
Name	:	JOHN GARRETT
Credential	:	PHARM.D.
Telephone Number	:	713-771-0061

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	07/19/2018

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