MEDICARE: MK PHARMACY SERVICES 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1275004509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MK PHARMACY SERVICES LLC

Provider Business Mailing Address
First Line	:	932 W DALLAS ST STE C
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-2260
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	932 W DALLAS ST STE C
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-2260
Country	:	US
Telephone Number	:	832-703-0067
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YESENIA LEOS WELLS
Credential	:
Telephone Number	:	832-793-0067

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	07/03/2019

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