MEDICARE: MRS. SHIRLEY CHACKO RPH

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	183500000X	Pharmacist	35827	TX

General Provider Information

NPI Number	:	1891790606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHIRLEY CHACKO RPH

Provider Business Mailing Address
First Line	:	8901 BOONE RD
Second Line	:	EL FRANCO LEE HEALTH CENTER PHARMACY
City	:	HOUSTON
State	:	TX
Zip	:	77099
Country	:	US
Telephone Number	:	281-454-0781
Fax Number	:	281-454-0780

Provider Business Practice Location Address
First Line	:	8901 BOONE RD
Second Line	:	EL FRANCO LEE HEALTH CENTER PHARMACY
City	:	HOUSTON
State	:	TX
Zip	:	77099
Country	:	US
Telephone Number	:	281-454-0781
Fax Number	:	281-454-0780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/19/2012

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