Provider Demographics
NPI:1568733053
Name:GALAXY MED LLC
Entity Type:Organization
Organization Name:GALAXY MED LLC
Other - Org Name:GALAXY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:281-496-6600
Mailing Address - Street 1:6655 TRAVIS ST STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1344
Mailing Address - Country:US
Mailing Address - Phone:281-496-6600
Mailing Address - Fax:281-496-6601
Practice Address - Street 1:6655 TRAVIS ST STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1344
Practice Address - Country:US
Practice Address - Phone:281-496-6600
Practice Address - Fax:281-496-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278413336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146591Medicaid
TX149084Medicaid