Provider Demographics
NPI:1073888301
Name:SHEVAT INC
Entity Type:Organization
Organization Name:SHEVAT INC
Other - Org Name:PECAN PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALESANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARPON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-514-8028
Mailing Address - Street 1:5537 LAWNDALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3837
Mailing Address - Country:US
Mailing Address - Phone:713-514-8028
Mailing Address - Fax:713-514-8078
Practice Address - Street 1:5537 LAWNDALE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3837
Practice Address - Country:US
Practice Address - Phone:713-514-8028
Practice Address - Fax:713-514-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5905534OtherNCPDP PROVIDER IDENTIFICATION NUMBER