Provider Demographics
NPI:1639580418
Name:360 PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:360 PHARMACY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:COCKERELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-557-1700
Mailing Address - Street 1:100 E NASA RD 1
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-5346
Mailing Address - Country:US
Mailing Address - Phone:281-557-1700
Mailing Address - Fax:281-557-8900
Practice Address - Street 1:100 E NASA RD 1
Practice Address - Street 2:SUITE 101
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5346
Practice Address - Country:US
Practice Address - Phone:281-557-1700
Practice Address - Fax:281-557-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX292683336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy