Provider Demographics
NPI:1508121195
Name:ARTEMIS PHARMACY, LLC
Entity Type:Organization
Organization Name:ARTEMIS PHARMACY, LLC
Other - Org Name:ARTEMIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:PEYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-975-0925
Mailing Address - Street 1:9640 COURT GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-2541
Mailing Address - Country:US
Mailing Address - Phone:281-933-8888
Mailing Address - Fax:
Practice Address - Street 1:9640 COURT GLEN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-2541
Practice Address - Country:US
Practice Address - Phone:281-933-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX280303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5906295OtherNCPDP PROVIDER IDENTIFICATION NUMBER