Provider Demographics
NPI:1093016362
Name:A HOLISTIC YOU PHARMACY
Entity Type:Organization
Organization Name:A HOLISTIC YOU PHARMACY
Other - Org Name:A HOLISTIC YOU PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS III
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-997-1644
Mailing Address - Street 1:5826 NEW TERRITORY BLVD
Mailing Address - Street 2:SUITE 613
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5948
Mailing Address - Country:US
Mailing Address - Phone:281-997-1644
Mailing Address - Fax:281-997-1643
Practice Address - Street 1:9330 BROADWAY ST
Practice Address - Street 2:SUITE 410
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7891
Practice Address - Country:US
Practice Address - Phone:281-997-1644
Practice Address - Fax:281-997-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX269913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5901651OtherNCPDP PROVIDER IDENTIFICATION NUMBER