Provider Demographics
NPI:1467707299
Name:PR PHARMACY
Entity Type:Organization
Organization Name:PR PHARMACY
Other - Org Name:PR PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALATHIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-605-4329
Mailing Address - Street 1:5819 HIGHWAY 6 STE 160
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4069
Mailing Address - Country:US
Mailing Address - Phone:832-230-8027
Mailing Address - Fax:832-230-8676
Practice Address - Street 1:5819 HIGHWAY 6 STE 160
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4069
Practice Address - Country:US
Practice Address - Phone:832-230-8027
Practice Address - Fax:832-230-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX280393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5906396OtherNCPDP PROVIDER IDENTIFICATION NUMBER