Provider Demographics
NPI:1073893038
Name:TABB PHARMACY LLC
Entity Type:Organization
Organization Name:TABB PHARMACY LLC
Other - Org Name:TABB PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:IKWUAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-772-8222
Mailing Address - Street 1:9730 SOUTHWEST FWY
Mailing Address - Street 2:SUITE UC 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1352
Mailing Address - Country:US
Mailing Address - Phone:713-772-8222
Mailing Address - Fax:713-772-8223
Practice Address - Street 1:9730 SOUTHWEST FWY STE UC
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1352
Practice Address - Country:US
Practice Address - Phone:713-772-8222
Practice Address - Fax:713-772-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX275893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5903782OtherNCPDP PROVIDER IDENTIFICATION NUMBER