MEDICARE: BLUE CITY 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1245857960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE CITY LLC

Provider Business Mailing Address
First Line	:	2646 S LOOP W STE 180A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5616
Country	:	US
Telephone Number	:	832-582-5290
Fax Number	:

Provider Business Practice Location Address
First Line	:	2646 S LOOP W STE 180A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5616
Country	:	US
Telephone Number	:	832-582-5290
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RACHAEL ALLES
Credential	:
Telephone Number	:	682-262-1120

Provider Enumeration Date	:	06/29/2020
Last Update Date	:	09/06/2023

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Directions to “BLUE CITY LLC ” Practice Location

Language	Start Address	Practice Location

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