Provider Demographics
NPI:1245739408
Name:MEMORIAL HERMANN PHARMACY SERVICES, LLC
Entity Type:Organization
Organization Name:MEMORIAL HERMANN PHARMACY SERVICES, LLC
Other - Org Name:MEMORIAL HERMANN HOME HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP - RISK MGMT. & LITIGATION
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-242-4456
Mailing Address - Street 1:21501 PARK ROW DR STE 210
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2425
Mailing Address - Country:US
Mailing Address - Phone:281-698-6175
Mailing Address - Fax:281-698-6147
Practice Address - Street 1:21501 PARK ROW DR STE 210
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449
Practice Address - Country:US
Practice Address - Phone:281-698-6175
Practice Address - Fax:281-698-6147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 333600000X, 3336C0004X
TX318603336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176353OtherPK