Provider Demographics
NPI:1457466492
Name:AMEX PHARMACY NO 3 INC
Entity Type:Organization
Organization Name:AMEX PHARMACY NO 3 INC
Other - Org Name:AMEX PHARMACY # 3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-641-0145
Mailing Address - Street 1:5990 AIRLINE DR
Mailing Address - Street 2:STE 150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4233
Mailing Address - Country:US
Mailing Address - Phone:713-451-8400
Mailing Address - Fax:713-451-8402
Practice Address - Street 1:5990 AIRLINE DR STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4237
Practice Address - Country:US
Practice Address - Phone:713-451-8400
Practice Address - Fax:713-451-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX228343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145329Medicaid
2099403OtherPK
TX145329Medicaid