Provider Demographics
NPI:1518971258
Name:EMMITE, FRED SAMUEL (RPH, CDM)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:SAMUEL
Last Name:EMMITE
Suffix:
Gender:M
Credentials:RPH, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18230 F.M. 1488
Mailing Address - Street 2:SUITE: 100
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354
Mailing Address - Country:US
Mailing Address - Phone:713-383-8875
Mailing Address - Fax:281-356-9659
Practice Address - Street 1:18230 F.M. 1488
Practice Address - Street 2:SUITE: 100
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354
Practice Address - Country:US
Practice Address - Phone:713-383-8875
Practice Address - Fax:281-356-9659
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23279183500000X, 1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No183500000XPharmacy Service ProvidersPharmacist