MEDICARE: K2 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	25747	TX

General Provider Information

NPI Number	:	1720358278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K2 PHARMACY

Provider Business Mailing Address
First Line	:	1348 FEDERAL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-6714
Country	:	US
Telephone Number	:	713-453-9103
Fax Number	:	713-453-9102

Provider Business Practice Location Address
First Line	:	1348 FEDERAL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-6714
Country	:	US
Telephone Number	:	713-453-9103
Fax Number	:	713-453-9102

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENNETH RAY HOPKINS
Credential	:
Telephone Number	:	713-453-9103

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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