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NPI Code Detail

MEDICARE: JUSTIN GREGORY FERNANDES PHARMD

MEDICARE: JUSTIN GREGORY FERNANDES PHARMD
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
1183500000XPharmacist61421TX

General Provider Information

NPI Number : 1285246579
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN GREGORY FERNANDES PHARMD
Provider Business Mailing Address
First Line : 6560 FANNIN ST STE 260
Second Line :
City : HOUSTON
State : TX
Zip : 77030-2728
Country : US
Telephone Number : 713-797-1410
Fax Number :
Provider Business Practice Location Address
First Line : 3701 KIRBY DR STE 1230
Second Line :
City : HOUSTON
State : TX
Zip : 77098-3916
Country : US
Telephone Number : 713-258-1913
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2020
Last Update Date : 12/22/2022

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