MEDICARE: RED OAK PHARMACY

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
2	333600000X	Pharmacy	29684	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2162116	OTHER		PK

General Provider Information

NPI Number	:	1861851347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED OAK PHARMACY

Provider Business Mailing Address
First Line	:	850 FM 1960 RD W STE R
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3413
Country	:	US
Telephone Number	:	281-587-0320
Fax Number	:	281-587-0321

Provider Business Practice Location Address
First Line	:	850 FM 1960 RD W STE R
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3413
Country	:	US
Telephone Number	:	281-587-0320
Fax Number	:	281-587-0321

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MICHAEL HAMILTON
Credential	:
Telephone Number	:	210-334-7381

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	07/25/2016

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Directions to “RED OAK PHARMACY ” Practice Location

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