Provider Demographics
NPI:1558465526
Name:ULTIMA CARE PHCY INC
Entity Type:Organization
Organization Name:ULTIMA CARE PHCY INC
Other - Org Name:MAXIMUM CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:SHANTELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:281-431-7119
Mailing Address - Street 1:16251 S POST OAK RD
Mailing Address - Street 2:STE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-4398
Mailing Address - Country:US
Mailing Address - Phone:281-438-6161
Mailing Address - Fax:281-438-6060
Practice Address - Street 1:16251 S POST OAK RD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-4397
Practice Address - Country:US
Practice Address - Phone:281-438-6161
Practice Address - Fax:281-438-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX250813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145637Medicaid
2098871OtherPK