Provider Demographics
NPI:1225484645
Name:SECURERX HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SECURERX HEALTHCARE, LLC
Other - Org Name:AMERICAN MEDICAL DIRECT SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-529-7076
Mailing Address - Street 1:1862 W. BITTERS, STE. 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248
Mailing Address - Country:US
Mailing Address - Phone:210-529-7076
Mailing Address - Fax:210-568-4147
Practice Address - Street 1:1214 N POST OAK RD STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7251
Practice Address - Country:US
Practice Address - Phone:832-404-6755
Practice Address - Fax:832-529-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion