MEDICARE: TX MED PHARMACY. INC

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	25698	TX

General Provider Information

NPI Number	:	1801089222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TX MED PHARMACY. INC

Provider Business Mailing Address
First Line	:	712 E TIDWELL RD STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-1842
Country	:	US
Telephone Number	:	713-451-4500
Fax Number	:	713-697-1609

Provider Business Practice Location Address
First Line	:	1002 FEDERAL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-4804
Country	:	US
Telephone Number	:	713-697-1600
Fax Number	:	713-697-1609

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	AKBAR HOSSAIN
Credential	:
Telephone Number	:	713-373-9944

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	08/21/2007

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