Provider Demographics
NPI:1144590704
Name:MEDPRUDENT INC.
Entity Type:Organization
Organization Name:MEDPRUDENT INC.
Other - Org Name:PRUDENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:HETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:UMEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-867-0040
Mailing Address - Street 1:6335 GULFTON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1112
Mailing Address - Country:US
Mailing Address - Phone:281-867-0400
Mailing Address - Fax:281-867-0042
Practice Address - Street 1:6335 GULFTON ST STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1112
Practice Address - Country:US
Practice Address - Phone:281-867-0040
Practice Address - Fax:281-867-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149234Medicaid