NPI age
18 years
Enumerated 2007-10-23
Across 126 active pharmacy providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 4500923753 | CLIA |
| 01 (TX) | 20614 | PHARMACY LICENSE |
| 01 (TX) | L0118826 | DPS |
| 01 (TX) | 4517162 | NCPDP |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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