Provider Demographics
NPI:1467556431
Name:UM PHARMACY
Entity Type:Organization
Organization Name:UM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-453-5100
Mailing Address - Street 1:963 FEDERAL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:963 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4801
Practice Address - Country:US
Practice Address - Phone:713-453-5100
Practice Address - Fax:713-453-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4542278OtherOTHER ID NUMBER-COMMERCIAL NUMBER