MEDICARE: KWIK MEDS PHARMACY LLC

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	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	27489	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	2128894	OTHER		PK

General Provider Information

NPI Number	:	1891091328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KWIK MEDS PHARMACY LLC

Provider Business Mailing Address
First Line	:	1900 NORTH LOOP W
Second Line	:	SUITE 170
City	:	HOUSTON
State	:	TX
Zip	:	77018-8100
Country	:	US
Telephone Number	:	281-501-2228
Fax Number	:	281-605-5657

Provider Business Practice Location Address
First Line	:	1900 NORTH LOOP W STE 170
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-8151
Country	:	US
Telephone Number	:	281-501-2228
Fax Number	:	281-605-5657

Authorized Official
Title or Position	:	OWNER
Name	:	SAJU ASTHAPPAN
Credential	:	PHARMACIST
Telephone Number	:	281-501-2228

Provider Enumeration Date	:	02/01/2011
Last Update Date	:	07/10/2015

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