Provider Demographics
NPI:1164747903
Name:PECCIO MEDI-MART PLUS L.L.C
Entity Type:Organization
Organization Name:PECCIO MEDI-MART PLUS L.L.C
Other - Org Name:PECCIO PHARMACY PLUS #II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NWAOBI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:713-780-7600
Mailing Address - Street 1:5615 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-6327
Mailing Address - Country:US
Mailing Address - Phone:713-780-7600
Mailing Address - Fax:713-780-7603
Practice Address - Street 1:5615 RICHMOND AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6327
Practice Address - Country:US
Practice Address - Phone:713-780-7600
Practice Address - Fax:713-780-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26858302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization