Provider Demographics
NPI:1114341369
Name:HEALTHCHOICE MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:HEALTHCHOICE MANAGEMENT SERVICES LLC
Other - Org Name:HEALTHCHOICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-838-1211
Mailing Address - Street 1:12930 DAIRY ASHFORD RD STE 303
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4666
Mailing Address - Country:US
Mailing Address - Phone:281-741-8358
Mailing Address - Fax:281-741-8486
Practice Address - Street 1:12930 DAIRY ASHFORD RD STE 303
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4666
Practice Address - Country:US
Practice Address - Phone:888-838-1211
Practice Address - Fax:281-741-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-08
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX288973336C0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144301OtherPK
2144301OtherPK