Provider Demographics
NPI:1467824599
Name:CEDRA PHARMACY HOUSTON LLC
Entity Type:Organization
Organization Name:CEDRA PHARMACY HOUSTON LLC
Other - Org Name:CEDRA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARNABY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-836-8886
Mailing Address - Street 1:724 ELTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-1687
Mailing Address - Country:US
Mailing Address - Phone:917-836-8886
Mailing Address - Fax:713-621-9621
Practice Address - Street 1:1607 S POST OAK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-2807
Practice Address - Country:US
Practice Address - Phone:713-621-0621
Practice Address - Fax:713-621-9621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302023336C0003X
3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148401Medicaid
2155114OtherPK
TX148401Medicaid