Provider Demographics
NPI:1093205528
Name:RELIEF MED PHARMACY LLC
Entity Type:Organization
Organization Name:RELIEF MED PHARMACY LLC
Other - Org Name:RELIEF MED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-228-6169
Mailing Address - Street 1:310 E DAVIS ST
Mailing Address - Street 2:STE #100
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2910
Mailing Address - Country:US
Mailing Address - Phone:936-703-5389
Mailing Address - Fax:936-703-5397
Practice Address - Street 1:310 E DAVIS ST
Practice Address - Street 2:STE 100
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2910
Practice Address - Country:US
Practice Address - Phone:936-703-5389
Practice Address - Fax:936-703-5397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX320143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177473OtherPK