Provider Demographics
NPI:1225373079
Name:BLUE COUGAR INVESTMENT L.L.C.
Entity Type:Organization
Organization Name:BLUE COUGAR INVESTMENT L.L.C.
Other - Org Name:MITCHELL RX PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ARTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-741-5104
Mailing Address - Street 1:5910 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1457
Mailing Address - Country:US
Mailing Address - Phone:713-741-5104
Mailing Address - Fax:713-741-5108
Practice Address - Street 1:4614 NASA PKWY
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-5414
Practice Address - Country:US
Practice Address - Phone:713-741-5104
Practice Address - Fax:713-741-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
TX283693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5907754OtherNCPDP PROVIDER IDENTIFICATION NUMBER