MEDICARE: HEALTHSCRIPTS OF AMERICA-SOUTHWEST TEXAS, LLC

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	29050	TX

General Provider Information

NPI Number	:	1689099673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHSCRIPTS OF AMERICA-SOUTHWEST TEXAS, LLC

Provider Business Mailing Address
First Line	:	6565 WEST LOOP S
Second Line	:	SUITE 110
City	:	BELLAIRE
State	:	TX
Zip	:	77401-3500
Country	:	US
Telephone Number	:	832-494-3210
Fax Number	:	832-494-3218

Provider Business Practice Location Address
First Line	:	2803 DULLES AVE
Second Line	:	SUITE 2817
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2950
Country	:	US
Telephone Number	:	855-299-3340
Fax Number	:	855-894-6409

Authorized Official
Title or Position	:	CEO
Name	:	KAMRAN NEZAMI
Credential	:
Telephone Number	:	832-494-3210

Provider Enumeration Date	:	02/27/2014
Last Update Date	:	02/27/2014

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