MEDICARE: SONEXUS HEALTH PHARMACY SERVICES

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	28718	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2142939	OTHER		PK

General Provider Information

NPI Number	:	1447680210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONEXUS HEALTH PHARMACY SERVICES

Provider Business Mailing Address
First Line	:	2730 EDMONDS LN
Second Line	:	SUITE 400
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-6731
Country	:	US
Telephone Number	:	877-369-6093
Fax Number	:	866-781-4998

Provider Business Practice Location Address
First Line	:	2730 EDMONDS LN STE 400
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-6731
Country	:	US
Telephone Number	:	972-350-9940
Fax Number	:	866-781-4998

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIKE MULLEN
Credential	:	RPH
Telephone Number	:	972-608-7203

Provider Enumeration Date	:	11/15/2013
Last Update Date	:	02/11/2016

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Directions to “SONEXUS HEALTH PHARMACY SERVICES ” Practice Location

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