Provider Demographics
NPI:1174853535
Name:PROVEN CARE PHARMACY LLC
Entity Type:Organization
Organization Name:PROVEN CARE PHARMACY LLC
Other - Org Name:PROVEN CARE PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORP-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GODSWILL
Authorized Official - Middle Name:
Authorized Official - Last Name:UNACHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-983-9333
Mailing Address - Street 1:13307 LARKHILL GARDENS LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7603
Mailing Address - Country:US
Mailing Address - Phone:281-983-9333
Mailing Address - Fax:281-983-9335
Practice Address - Street 1:10950 BISSONNET ST STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-1715
Practice Address - Country:US
Practice Address - Phone:281-983-9333
Practice Address - Fax:281-983-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX267583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123398OtherPK
TX148917Medicaid