Provider Demographics
NPI:1164037594
Name:NANES PHARMACY LLC
Entity Type:Organization
Organization Name:NANES PHARMACY LLC
Other - Org Name:NANES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABBIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-781-9796
Mailing Address - Street 1:17030 NANES DR STE 105A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2503
Mailing Address - Country:US
Mailing Address - Phone:832-666-2065
Mailing Address - Fax:832-666-2089
Practice Address - Street 1:17030 NANES DR STE 105A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2503
Practice Address - Country:US
Practice Address - Phone:832-666-2065
Practice Address - Fax:832-666-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150321Medicaid