MEDICARE: ST HOPE FOUNDATION 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	28015	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2134933	OTHER		PK

General Provider Information

NPI Number	:	1689932568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST HOPE FOUNDATION INC

Provider Business Mailing Address
First Line	:	6200 SAVOY DR
Second Line	:	SUITE 540
City	:	HOUSTON
State	:	TX
Zip	:	77036-3300
Country	:	US
Telephone Number	:	713-778-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 S FRAZIER ST STE 105
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-4475
Country	:	US
Telephone Number	:	936-494-2455
Fax Number	:	877-712-2152

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	TIMIKA SAM-COOPER
Credential	:
Telephone Number	:	713-778-1300

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/11/2022

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Directions to “ST HOPE FOUNDATION INC ” Practice Location

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