Provider Demographics
NPI:1619013232
Name:CULLEN CARE PHARMACY INC
Entity Type:Organization
Organization Name:CULLEN CARE PHARMACY INC
Other - Org Name:CULLEN CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-747-2100
Mailing Address - Street 1:5751 BLYTHEWOOD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-5402
Mailing Address - Country:US
Mailing Address - Phone:713-747-2100
Mailing Address - Fax:713-747-2105
Practice Address - Street 1:5751 BLYTHEWOOD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-5402
Practice Address - Country:US
Practice Address - Phone:713-747-2100
Practice Address - Fax:713-747-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145769Medicaid
2099936OtherPK