Provider Demographics
NPI:1104179696
Name:COLT STRATEGIES LLC
Entity Type:Organization
Organization Name:COLT STRATEGIES LLC
Other - Org Name:TEJAS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:IMBER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-419-6228
Mailing Address - Street 1:320 SOUTHMORE AVE STE 325B
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-1135
Mailing Address - Country:US
Mailing Address - Phone:713-472-3736
Mailing Address - Fax:713-472-3628
Practice Address - Street 1:320 SOUTHMORE AVE STE 325B
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-1135
Practice Address - Country:US
Practice Address - Phone:713-472-3736
Practice Address - Fax:713-472-3628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLT STRATEGIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy