Provider Demographics
NPI:1558628339
Name:YOUR PHARMACY INC
Entity Type:Organization
Organization Name:YOUR PHARMACY INC
Other - Org Name:YOUR PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-781-1010
Mailing Address - Street 1:7400 HARWIN DR STE 253
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2030
Mailing Address - Country:US
Mailing Address - Phone:713-781-1010
Mailing Address - Fax:713-781-1317
Practice Address - Street 1:7400 HARWIN DR STE 253
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2030
Practice Address - Country:US
Practice Address - Phone:713-781-1010
Practice Address - Fax:713-781-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5905926OtherNCPDP PROVIDER IDENTIFICATION NUMBER