MEDICARE: CURA VITA, 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

General Provider Information

NPI Number	:	1255957791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CURA VITA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 6963
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77325-6963
Country	:	US
Telephone Number	:	281-225-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	13176 W LAKE HOUSTON PKWY STE 1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-5381
Country	:	US
Telephone Number	:	281-225-4300
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. MARIE EKPEMA
Credential	:	PHARMD
Telephone Number	:	281-225-4300

Provider Enumeration Date	:	06/20/2020
Last Update Date	:	06/20/2020

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