Provider Demographics
NPI:1619199908
Name:ADRX INC
Entity Type:Organization
Organization Name:ADRX INC
Other - Org Name:MANGUM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MARISA
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:713-208-7252
Mailing Address - Street 1:2025 MANGUM RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8529
Mailing Address - Country:US
Mailing Address - Phone:713-812-8400
Mailing Address - Fax:713-812-8401
Practice Address - Street 1:2025 MANGUM RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8529
Practice Address - Country:US
Practice Address - Phone:713-812-8400
Practice Address - Fax:713-812-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy