MEDICARE: GULF BANK PHARMACY

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	28625	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2145171	OTHER		PK

General Provider Information

NPI Number	:	1457761777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF BANK PHARMACY

Provider Business Mailing Address
First Line	:	8906 NORTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-2727
Country	:	US
Telephone Number	:	281-931-4171
Fax Number	:

Provider Business Practice Location Address
First Line	:	8906 NORTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-2727
Country	:	US
Telephone Number	:	281-931-4171
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARMEN DACOSTA
Credential	:
Telephone Number	:	281-931-4171

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	05/08/2014

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Directions to “GULF BANK PHARMACY ” Practice Location

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