Provider Demographics
NPI:1497097968
Name:NERXD LLC
Entity Type:Organization
Organization Name:NERXD LLC
Other - Org Name:CYPRESS COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, RPH
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:832-617-0290
Mailing Address - Street 1:9511 HUFFMEISTER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2892
Mailing Address - Country:US
Mailing Address - Phone:832-617-0290
Mailing Address - Fax:832-510-4003
Practice Address - Street 1:9511 HUFFMEISTER RD STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2892
Practice Address - Country:US
Practice Address - Phone:832-617-0290
Practice Address - Fax:832-510-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.019556333600000X
AZY0064803336C0003X, 3336C0004X
WYNR-510823336C0003X
WAPHNR.FO.605535503336C0003X
UT9257855-17083336C0003X
TX284763336C0003X
FLPH293243336C0004X
GAPHNR0008023336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNOT CURRENTLY REGISTMedicaid
2140372OtherPK