Provider Demographics
NPI:1518454156
Name:MISSOURI CITY PHARMACY LLC
Entity Type:Organization
Organization Name:MISSOURI CITY PHARMACY LLC
Other - Org Name:MISSOURI CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MIKALAI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIUBENZY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-300-0662
Mailing Address - Street 1:1531 HWY 90A
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-1226
Mailing Address - Country:US
Mailing Address - Phone:281-393-4040
Mailing Address - Fax:281-393-4041
Practice Address - Street 1:1531 HIGHWAY 90 A
Practice Address - Street 2:SUITE - 200
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-1226
Practice Address - Country:US
Practice Address - Phone:281-393-4040
Practice Address - Fax:281-393-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31971333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177136OtherPK