Provider Demographics
NPI:1588809214
Name:TEXAS PROFESSIONAL PHARMACY LLC
Entity Type:Organization
Organization Name:TEXAS PROFESSIONAL PHARMACY LLC
Other - Org Name:TEXAS PROFESSIONAL PHARMACY- MAGNOLIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V PRESIDENT, PIC
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:GULAMHUSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:281-356-2216
Mailing Address - Street 1:18602 FM 1488 RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-8508
Mailing Address - Country:US
Mailing Address - Phone:281-356-2216
Mailing Address - Fax:281-356-6440
Practice Address - Street 1:18602 FM 1488 RD
Practice Address - Street 2:SUITE 700
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-8508
Practice Address - Country:US
Practice Address - Phone:281-356-2216
Practice Address - Fax:281-356-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26399333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118156OtherPK
TX146008Medicaid