Provider Demographics
NPI:1356640254
Name:EAST TEXAS CLINICAL SERVICES, INC
Entity Type:Organization
Organization Name:EAST TEXAS CLINICAL SERVICES, INC
Other - Org Name:CHI ST. LUKE'S HEALTH NEIGHBORHOOD PHARMACY #3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-246-8066
Mailing Address - Street 1:17521 ST. LUKE'S WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384
Mailing Address - Country:US
Mailing Address - Phone:936-447-9432
Mailing Address - Fax:832-201-8622
Practice Address - Street 1:17521 ST. LUKE'S WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:936-447-9432
Practice Address - Fax:832-201-8622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
TX314583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy