Provider Demographics
NPI:1144589847
Name:TD PHARMACY
Entity Type:Organization
Organization Name:TD PHARMACY
Other - Org Name:TD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF ADMIN & COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-563-9799
Mailing Address - Street 1:12319 BELLAIRE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2590
Mailing Address - Country:US
Mailing Address - Phone:281-741-8472
Mailing Address - Fax:281-741-8456
Practice Address - Street 1:12319 BELLAIRE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2590
Practice Address - Country:US
Practice Address - Phone:281-741-8472
Practice Address - Fax:281-741-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX280453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135211OtherPK
TX146579Medicaid