Provider Demographics
NPI:1598309007
Name:MEDICI PHARMACY LLC
Entity Type:Organization
Organization Name:MEDICI PHARMACY LLC
Other - Org Name:MEDICI PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TUYETANH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-993-7770
Mailing Address - Street 1:12930 DAIRY ASHFORD RD STE 702
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4667
Mailing Address - Country:US
Mailing Address - Phone:817-863-8331
Mailing Address - Fax:
Practice Address - Street 1:12930 DAIRY ASHFORD RD STE 702
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4667
Practice Address - Country:US
Practice Address - Phone:713-993-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19351639OtherTEXAS DRIVER'S LICENSE