Provider Demographics
NPI:1649584905
Name:A & E PHARMACY LLC
Entity Type:Organization
Organization Name:A & E PHARMACY LLC
Other - Org Name:BAYSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-443-9612
Mailing Address - Street 1:411 W PARKER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-3202
Mailing Address - Country:US
Mailing Address - Phone:832-298-7551
Mailing Address - Fax:281-712-7795
Practice Address - Street 1:411 W PARKER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-3202
Practice Address - Country:US
Practice Address - Phone:713-609-9163
Practice Address - Fax:281-712-7795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5900659OtherNCPDP PROVIDER IDENTIFICATION NUMBER