Provider Demographics
NPI:1457671042
Name:UNIV OF TEXAS MD ANDERSON CANCER CENTER
Entity Type:Organization
Organization Name:UNIV OF TEXAS MD ANDERSON CANCER CENTER
Other - Org Name:UNIV OF TEXAS MD ANDERSON CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAJEUNESSE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-792-2753
Mailing Address - Street 1:PO BOX 4727
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:UNIT 90
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-6125
Practice Address - Fax:713-794-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX060263336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4541480OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX112672402Medicaid
4541480OtherNCPDP PROVIDER IDENTIFICATION NUMBER