MEDICARE: I-10 ATRIUM 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	26304	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4551948	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1861636243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I-10 ATRIUM PHARMACY INC

Provider Business Mailing Address
First Line	:	8014 TOMAHAWK TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77050-5012
Country	:	US
Telephone Number	:	713-382-8049
Fax Number	:	281-454-7703

Provider Business Practice Location Address
First Line	:	11821 EAST FWY
Second Line	:	STE 300
City	:	HOUSTON
State	:	TX
Zip	:	77029-1975
Country	:	US
Telephone Number	:	713-453-8000
Fax Number	:	713-453-8001

Authorized Official
Title or Position	:	OWNER
Name	:	EDITH BAUTISTA
Credential	:
Telephone Number	:	713-382-8049

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	03/15/2011

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