MEDICARE: P J WORSHAM MANAGEMENT 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
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1316534126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P J WORSHAM MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	8103 CREEKBEND DR STE G
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1556
Country	:	US
Telephone Number	:	832-582-5252
Fax Number	:	832-582-5847

Provider Business Practice Location Address
First Line	:	8103 CREEKBEND DR STE G
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1556
Country	:	US
Telephone Number	:	832-582-5252
Fax Number	:	832-582-5847

Authorized Official
Title or Position	:	OWNER
Name	:	PAMELA THOMAS-WORSHAM
Credential	:
Telephone Number	:	832-582-5252

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	12/28/2020

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