Provider Demographics
NPI:1558654723
Name:SUGAR PINE PHARMACY
Entity Type:Organization
Organization Name:SUGAR PINE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX VP
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-397-6500
Mailing Address - Street 1:1972 FM 1960 RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1972 FM 1960 RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3206
Practice Address - Country:US
Practice Address - Phone:281-397-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy