Provider Demographics
NPI:1275884033
Name:STATE PHARMACY & INFUSION CENTER, LLC
Entity Type:Organization
Organization Name:STATE PHARMACY & INFUSION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOARER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-509-2639
Mailing Address - Street 1:13111 WESTHEIMER RD
Mailing Address - Street 2:SUITE #212
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5546
Mailing Address - Country:US
Mailing Address - Phone:832-230-3804
Mailing Address - Fax:832-230-3839
Practice Address - Street 1:13111 WESTHEIMER RD
Practice Address - Street 2:SUITE #212
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5546
Practice Address - Country:US
Practice Address - Phone:832-230-3804
Practice Address - Fax:832-230-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy