Provider Demographics
NPI:1407121411
Name:TRIPLE A PHARMACY CORPORATION
Entity Type:Organization
Organization Name:TRIPLE A PHARMACY CORPORATION
Other - Org Name:TRIPLE A PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-487-0607
Mailing Address - Street 1:11450 SPACE CENTER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3641
Mailing Address - Country:US
Mailing Address - Phone:281-487-0607
Mailing Address - Fax:281-487-0609
Practice Address - Street 1:11450 SPACE CENTER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059-3641
Practice Address - Country:US
Practice Address - Phone:281-487-0607
Practice Address - Fax:281-487-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274393336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147068Medicaid
2134187OtherPK