MEDICARE: ELSA M MURILLO

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	28223	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
2	5907160	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1811247406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELSA M MURILLO

Provider Business Mailing Address
First Line	:	3815 IRVINGTON BLVD STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-4843
Country	:	US
Telephone Number	:	713-694-8399
Fax Number	:	713-694-8391

Provider Business Practice Location Address
First Line	:	3815 IRVINGTON BLVD STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-4843
Country	:	US
Telephone Number	:	713-694-8399
Fax Number	:	713-694-8391

Authorized Official
Title or Position	:	OWNER
Name	:	ELSA MURILLO
Credential	:
Telephone Number	:	713-694-8399

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	02/24/2022

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Directions to “ELSA M MURILLO ” Practice Location

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