MEDICARE: RAPHA PHARMACY

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
2	333600000X	Pharmacy	21402	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4521301	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720193766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPHA PHARMACY

Provider Business Mailing Address
First Line	:	12600 BISSONNET ST STE E1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-1395
Country	:	US
Telephone Number	:	832-328-1855
Fax Number	:	832-328-1845

Provider Business Practice Location Address
First Line	:	12600 BISSONNET ST STE E1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-1395
Country	:	US
Telephone Number	:	832-328-1855
Fax Number	:	832-328-1845

Authorized Official
Title or Position	:	DIR OF PHRMCY
Name	:	PAMELA FOMUNUNG
Credential	:
Telephone Number	:	832-328-1855

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	10/08/2008

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Directions to “RAPHA PHARMACY ” Practice Location

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