Provider Demographics
NPI:1003227869
Name:AFYA SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:AFYA SPECIALTY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOMBA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:713-298-7795
Mailing Address - Street 1:17490 HIGHWAY 3
Mailing Address - Street 2:SUITE B200
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4160
Mailing Address - Country:US
Mailing Address - Phone:281-724-1426
Mailing Address - Fax:
Practice Address - Street 1:17490 HIGHWAY 3
Practice Address - Street 2:SUITE B200
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4160
Practice Address - Country:US
Practice Address - Phone:281-724-1426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX292713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy