MEDICARE: XAVIER PHARMACY III

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	26078	TX

General Provider Information

NPI Number	:	1619138443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XAVIER PHARMACY III

Provider Business Mailing Address
First Line	:	96 BERRY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3057
Country	:	US
Telephone Number	:	713-697-1400
Fax Number	:	713-697-1416

Provider Business Practice Location Address
First Line	:	96 BERRY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3057
Country	:	US
Telephone Number	:	713-697-1400
Fax Number	:	713-697-1416

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM E GUTIERREZ
Credential	:
Telephone Number	:	713-697-1400

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	06/24/2008

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Directions to “XAVIER PHARMACY III ” Practice Location

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