Provider Demographics
NPI:1538474184
Name:CMSB HOLDINGS INC
Entity Type:Organization
Organization Name:CMSB HOLDINGS INC
Other - Org Name:PROCARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHAROLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-236-2914
Mailing Address - Street 1:16300 KUYKENDAHL
Mailing Address - Street 2:SUITE 370
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068
Mailing Address - Country:US
Mailing Address - Phone:281-580-4500
Mailing Address - Fax:281-580-4503
Practice Address - Street 1:16300 KUYKENDAHL RD STE 370
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-2751
Practice Address - Country:US
Practice Address - Phone:281-580-4500
Practice Address - Fax:281-580-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX270323336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126040OtherPK
TX146212Medicaid
TX149335Medicaid