Provider Demographics
NPI:1356075469
Name:FM 1488 PHARMACY LLC
Entity Type:Organization
Organization Name:FM 1488 PHARMACY LLC
Other - Org Name:FM 1488 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OFFICER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRACHI
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-864-1184
Mailing Address - Street 1:4849 FM 1488 RD STE 1500
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4560
Mailing Address - Country:US
Mailing Address - Phone:281-864-1184
Mailing Address - Fax:
Practice Address - Street 1:4849 FM 1488 RD STE 1500
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77354-4560
Practice Address - Country:US
Practice Address - Phone:281-864-1184
Practice Address - Fax:281-864-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150562Medicaid