Provider Demographics
NPI:1376829358
Name:GLORIA'S MEDICATION THERAPY MANAGEMENT SERVICES, PLLC
Entity Type:Organization
Organization Name:GLORIA'S MEDICATION THERAPY MANAGEMENT SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT PHARMACIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DAVIS-BRACKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH,FASCP
Authorized Official - Phone:281-467-8198
Mailing Address - Street 1:1914 EASTMONT LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3195
Mailing Address - Country:US
Mailing Address - Phone:281-467-8198
Mailing Address - Fax:
Practice Address - Street 1:1914 EASTMONT LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3195
Practice Address - Country:US
Practice Address - Phone:281-467-8198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33536302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization