Provider Demographics
NPI:1467098608
Name:CLASSICO ENTERPRISE LLC
Entity Type:Organization
Organization Name:CLASSICO ENTERPRISE LLC
Other - Org Name:MORTAR & PESTLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:UZOUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-571-7877
Mailing Address - Street 1:10109 BISSONNET ST STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7859
Mailing Address - Country:US
Mailing Address - Phone:281-571-7877
Mailing Address - Fax:281-653-7877
Practice Address - Street 1:10109 BISSONNET ST STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7859
Practice Address - Country:US
Practice Address - Phone:713-367-1180
Practice Address - Fax:281-653-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy