MEDICARE: BARBOUR NEIGHBORHOOD PHARMACY 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	27467	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5903263	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1790078814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARBOUR NEIGHBORHOOD PHARMACY LLC

Provider Business Mailing Address
First Line	:	2910 ANTOINE DR
Second Line	:	STE A 107
City	:	HOUSTON
State	:	TX
Zip	:	77092-7062
Country	:	US
Telephone Number	:	713-263-9640
Fax Number	:	713-263-9645

Provider Business Practice Location Address
First Line	:	2910 ANTOINE DR STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-7062
Country	:	US
Telephone Number	:	713-263-9640
Fax Number	:	713-263-9645

Authorized Official
Title or Position	:	OWNER
Name	:	HOWARD BARBOUR
Credential	:
Telephone Number	:	979-451-0807

Provider Enumeration Date	:	05/23/2011
Last Update Date	:	06/02/2011

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