MEDICARE: SUCCESSION EQUITY GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3336C0003X	Community/Retail Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4575493	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1639190697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUCCESSION EQUITY GROUP

Provider Business Mailing Address
First Line	:	3740 CARTWRIGHT RD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459
Country	:	US
Telephone Number	:	281-499-4555
Fax Number	:	281-499-7088

Provider Business Practice Location Address
First Line	:	3740 CARTWRIGHT RD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459
Country	:	US
Telephone Number	:	281-499-4555
Fax Number	:	281-499-7088

Authorized Official
Title or Position	:	OWNER
Name	:	MR. HANNA HOVHANNES ELCHEMMAS
Credential	:	PHARMD
Telephone Number	:	281-499-4555

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	10/14/2021

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Directions to “SUCCESSION EQUITY GROUP ” Practice Location

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