MEDICARE: CRYSONCARE 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	27254	TX

General Provider Information

NPI Number	:	1841602489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSONCARE PHARMACY INC

Provider Business Mailing Address
First Line	:	22325 GOSLING RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-4409
Country	:	US
Telephone Number	:	713-995-7577
Fax Number	:	866-441-5469

Provider Business Practice Location Address
First Line	:	22325 GOSLING RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-4409
Country	:	US
Telephone Number	:	713-995-7577
Fax Number	:	866-441-5469

Authorized Official
Title or Position	:	OFFICER
Name	:	MR. JAMES ANTHONY LAPEYROUSE
Credential	:
Telephone Number	:	713-995-7577

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	06/02/2014

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