Provider Demographics
NPI:1174644637
Name:CMPW HOLDINGS INC
Entity Type:Organization
Organization Name:CMPW HOLDINGS INC
Other - Org Name:MASTERY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-330-5044
Mailing Address - Street 1:2950 CULLEN BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3921
Mailing Address - Country:US
Mailing Address - Phone:713-665-9995
Mailing Address - Fax:713-665-9996
Practice Address - Street 1:2950 CULLEN BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3921
Practice Address - Country:US
Practice Address - Phone:713-665-9995
Practice Address - Fax:713-665-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336S0011X
TX254273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145801Medicaid
2100029OtherPK