Provider Demographics
NPI:1467509943
Name:FD PHARMACY INC
Entity Type:Organization
Organization Name:FD PHARMACY INC
Other - Org Name:FULSHEAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:832-868-9170
Mailing Address - Street 1:29810 FM 1093 RD
Mailing Address - Street 2:STE B
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-3922
Mailing Address - Country:US
Mailing Address - Phone:281-346-2020
Mailing Address - Fax:281-533-0136
Practice Address - Street 1:29810 FM 1093 RD
Practice Address - Street 2:STE B
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-3922
Practice Address - Country:US
Practice Address - Phone:281-346-2020
Practice Address - Fax:281-533-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2099906OtherPK