Provider Demographics
NPI:1083724280
Name:EAST LOOP HOLDINGS, INC.
Entity Type:Organization
Organization Name:EAST LOOP HOLDINGS, INC.
Other - Org Name:EAST LOOP PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORP PRES
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-682-6565
Mailing Address - Street 1:9343 NORTH LOOP E STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-1257
Mailing Address - Country:US
Mailing Address - Phone:713-682-6565
Mailing Address - Fax:713-682-6572
Practice Address - Street 1:9343 NORTH LOOP E STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1257
Practice Address - Country:US
Practice Address - Phone:713-682-6565
Practice Address - Fax:713-682-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy