Provider Demographics
NPI:1619358967
Name:3D&S SUPREME PHARMACY
Entity Type:Organization
Organization Name:3D&S SUPREME PHARMACY
Other - Org Name:3D&S SUPREME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NJIBAMUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-585-1642
Mailing Address - Street 1:203 E DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-3159
Mailing Address - Country:US
Mailing Address - Phone:936-494-3781
Mailing Address - Fax:936-494-3784
Practice Address - Street 1:203 E DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-3159
Practice Address - Country:US
Practice Address - Phone:936-494-3781
Practice Address - Fax:936-494-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29914333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152267OtherPK