Provider Demographics
NPI:1124197074
Name:POWER CENTER PHARMACY INC
Entity Type:Organization
Organization Name:POWER CENTER PHARMACY INC
Other - Org Name:POWER CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-721-3303
Mailing Address - Street 1:12401 S POST OAK RD
Mailing Address - Street 2:STE E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-2020
Mailing Address - Country:US
Mailing Address - Phone:713-721-3303
Mailing Address - Fax:713-721-3299
Practice Address - Street 1:12401 S POST OAK RD
Practice Address - Street 2:STE E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-2020
Practice Address - Country:US
Practice Address - Phone:713-721-3303
Practice Address - Fax:713-721-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX253343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14382Medicaid
2105508OtherPK