MEDICARE: PRIME PHC 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	20643	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	4517201	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1902911944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME PHC INC

Provider Business Mailing Address
First Line	:	477 W PARKER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-3202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	477 W PARKER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-3202
Country	:	US
Telephone Number	:	713-696-9977
Fax Number	:	713-696-9988

Authorized Official
Title or Position	:	PIC
Name	:	CHUL CHOI
Credential	:
Telephone Number	:	713-696-9977

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	02/02/2009

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Directions to “PRIME PHC INC ” Practice Location

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