Provider Demographics
NPI:1114283231
Name:A&W PHARMACY
Entity Type:Organization
Organization Name:A&W PHARMACY
Other - Org Name:A & W PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHAMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-286-7710
Mailing Address - Street 1:435 EL DORADO BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-2200
Mailing Address - Country:US
Mailing Address - Phone:281-286-7710
Mailing Address - Fax:281-286-7783
Practice Address - Street 1:435 EL DORADO BLVD STE 6
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-2200
Practice Address - Country:US
Practice Address - Phone:281-286-7710
Practice Address - Fax:281-286-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX279463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135185OtherPK
TX146589Medicaid