Provider Demographics
NPI:1629180534
Name:PRO HEALTH RX
Entity Type:Organization
Organization Name:PRO HEALTH RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:UMOH
Authorized Official - Middle Name:
Authorized Official - Last Name:OFFIONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-991-2443
Mailing Address - Street 1:8405 ALMEDA GENOA RD
Mailing Address - Street 2:STE Z
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-2503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8405 ALMEDA GENOA RD
Practice Address - Street 2:STE Z
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-2503
Practice Address - Country:US
Practice Address - Phone:713-991-2443
Practice Address - Fax:713-991-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX231603336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145422Medicaid
4534992OtherOTHER ID NUMBER-COMMERCIAL NUMBER