Provider Demographics
NPI:1144235748
Name:THE HARRIS CENTER FOR MENTAL HEALTH AND IDD
Entity Type:Organization
Organization Name:THE HARRIS CENTER FOR MENTAL HEALTH AND IDD
Other - Org Name:NORTHWEST CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BABIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-970-3385
Mailing Address - Street 1:3737 DACOMA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8905
Mailing Address - Country:US
Mailing Address - Phone:713-970-8485
Mailing Address - Fax:713-970-8506
Practice Address - Street 1:3737 DACOMA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8905
Practice Address - Country:US
Practice Address - Phone:713-970-8485
Practice Address - Fax:713-970-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114343336C0002X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100610OtherPK