Provider Demographics
NPI:1326170580
Name:HOMESTEAD PHARMACY
Entity Type:Organization
Organization Name:HOMESTEAD PHARMACY
Other - Org Name:DELLS PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PORCARELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-631-3117
Mailing Address - Street 1:8300 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77028-2145
Mailing Address - Country:US
Mailing Address - Phone:713-631-3117
Mailing Address - Fax:713-631-1290
Practice Address - Street 1:8300 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-2145
Practice Address - Country:US
Practice Address - Phone:713-631-3117
Practice Address - Fax:713-631-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4503783Medicaid