MEDICARE: UNIQUE ACS GROUP 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

General Provider Information

NPI Number	:	1700105509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIQUE ACS GROUP LLC

Provider Business Mailing Address
First Line	:	4106 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4808
Country	:	US
Telephone Number	:	713-772-6060
Fax Number	:	713-526-6064

Provider Business Practice Location Address
First Line	:	4106 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4808
Country	:	US
Telephone Number	:	713-772-6060
Fax Number	:	713-526-6064

Authorized Official
Title or Position	:	REGISTER NURSE
Name	:	MS. ANITA CLARICE SCOTT
Credential	:	BSN
Telephone Number	:	504-669-2726

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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