Provider Demographics
NPI:1538683875
Name:TERRASCON HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:TERRASCON HEALTHCARE CORPORATION
Other - Org Name:KLEINWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-953-2926
Mailing Address - Street 1:7623 LOUETTA RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7237
Mailing Address - Country:US
Mailing Address - Phone:832-953-2926
Mailing Address - Fax:832-953-2927
Practice Address - Street 1:7623 LOUETTA RD STE 104
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7237
Practice Address - Country:US
Practice Address - Phone:832-953-2926
Practice Address - Fax:832-953-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BN1400X, 333600000X, 3336C0002X, 3336L0003X, 3336S0011X
TX314433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169409OtherPK