MEDICARE: AZTEC RX INC

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	26490	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4552508	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1205062445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZTEC RX INC

Provider Business Mailing Address
First Line	:	6243 FAIRMONT PKWY
Second Line	:	STE 206
City	:	PASADENA
State	:	TX
Zip	:	77505-4045
Country	:	US
Telephone Number	:	281-998-1100
Fax Number	:	281-998-1104

Provider Business Practice Location Address
First Line	:	6243 FAIRMONT PKWY STE 206
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-4047
Country	:	US
Telephone Number	:	281-998-1100
Fax Number	:	281-998-1104

Authorized Official
Title or Position	:	PHARMACIST-IN-CHARGE
Name	:	GEORGE BALANDRAN
Credential	:
Telephone Number	:	832-607-7452

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/19/2009

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Directions to “AZTEC RX INC ” Practice Location

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