MEDICARE: HEALTHCO PHARMACY CORP

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	3336C0004X	Compounding Pharmacy	26275	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780025155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCO PHARMACY CORP

Provider Business Mailing Address
First Line	:	5730 CHIMNEY ROCK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2713
Country	:	US
Telephone Number	:	713-218-6337
Fax Number	:	713-218-6333

Provider Business Practice Location Address
First Line	:	5730 CHIMNEY ROCK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2713
Country	:	US
Telephone Number	:	713-218-6337
Fax Number	:	713-218-6333

Authorized Official
Title or Position	:	PHARMACY OWNER
Name	:	BRENDA SUE RICHARDSON
Credential	:	RPH
Telephone Number	:	713-218-6337

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	07/12/2013

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Directions to “HEALTHCO PHARMACY CORP ” Practice Location

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