Provider Demographics
NPI:1407196470
Name:E-MED PHARMACY LLC
Entity Type:Organization
Organization Name:E-MED PHARMACY LLC
Other - Org Name:E-MED PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KEKII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-276-4506
Mailing Address - Street 1:1306 BELL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-6608
Mailing Address - Country:US
Mailing Address - Phone:314-276-4506
Mailing Address - Fax:281-497-3225
Practice Address - Street 1:12638 BISSONNET ST STE G
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-1479
Practice Address - Country:US
Practice Address - Phone:281-741-5289
Practice Address - Fax:832-230-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX284603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149496Medicaid
2139550OtherPK