Provider Demographics
NPI:1356652713
Name:WEST HOUSTON SPECIALTY PHARMACY
Entity Type:Organization
Organization Name:WEST HOUSTON SPECIALTY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:KHANDOKER
Authorized Official - Middle Name:RAFIQUL
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:281-691-0419
Mailing Address - Street 1:12579 RICHMOND AVE
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2552
Mailing Address - Country:US
Mailing Address - Phone:281-556-9477
Mailing Address - Fax:281-558-8505
Practice Address - Street 1:12579 RICHMOND AVE
Practice Address - Street 2:SUITE 300A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2552
Practice Address - Country:US
Practice Address - Phone:281-556-9477
Practice Address - Fax:281-558-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX269393336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR0173117OtherTEXAS DEPARTMENT OF PUBLIC SAFETY
TX26939OtherTEXAS STATE BOARD OF PHARMACY
TX26939OtherTEXAS STATE BOARD OF PHARMACY