Provider Demographics
NPI:1639601537
Name:HEALTHY STRIDES RX LLC
Entity Type:Organization
Organization Name:HEALTHY STRIDES RX LLC
Other - Org Name:HEALTHY STRIDES RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-721-4070
Mailing Address - Street 1:4401 EMANCIPATION AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5221
Mailing Address - Country:US
Mailing Address - Phone:281-888-2235
Mailing Address - Fax:281-888-2277
Practice Address - Street 1:4401 EMANCIPATION AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5221
Practice Address - Country:US
Practice Address - Phone:281-888-2235
Practice Address - Fax:281-888-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX313493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168857OtherPK