Provider Demographics
NPI:1588015689
Name:MAIN, HOUSTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOUSTON
Middle Name:
Last Name:MAIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 GATEWAY CENTRE BLVD
Mailing Address - Street 2:300
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6228
Mailing Address - Country:US
Mailing Address - Phone:919-460-3967
Mailing Address - Fax:
Practice Address - Street 1:2100 GATEWAY CENTRE BLVD
Practice Address - Street 2:300
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6228
Practice Address - Country:US
Practice Address - Phone:919-460-3967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC25986OtherNCBOP