MEDICARE: ULTIMA CARE PHCY INC

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	25081	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2098871	OTHER		PK

General Provider Information

NPI Number	:	1558465526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMA CARE PHCY INC

Provider Business Mailing Address
First Line	:	16251 S POST OAK RD
Second Line	:	STE A
City	:	HOUSTON
State	:	TX
Zip	:	77053-4398
Country	:	US
Telephone Number	:	281-438-6161
Fax Number	:	281-438-6060

Provider Business Practice Location Address
First Line	:	16251 S POST OAK RD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-4397
Country	:	US
Telephone Number	:	281-438-6161
Fax Number	:	281-438-6060

Authorized Official
Title or Position	:	PIC
Name	:	SHANTELL WILLIAMS
Credential	:	RPH
Telephone Number	:	281-431-7119

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	06/27/2016

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Directions to “ULTIMA CARE PHCY INC ” Practice Location

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