Provider Demographics
NPI:1568502722
Name:CLINICAL CARE PHARMACY
Entity Type:Organization
Organization Name:CLINICAL CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ANJANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-272-8700
Mailing Address - Street 1:2770 N SAM HOUSTON PKWY W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77038-1206
Mailing Address - Country:US
Mailing Address - Phone:281-272-8700
Mailing Address - Fax:281-272-8705
Practice Address - Street 1:2770 N SAM HOUSTON PKWY W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77038-1206
Practice Address - Country:US
Practice Address - Phone:281-272-8700
Practice Address - Fax:281-272-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy