Provider Demographics
NPI:1659096709
Name:GENPHARM LLC
Entity Type:Organization
Organization Name:GENPHARM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWNTAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-596-6260
Mailing Address - Street 1:2901 WILCREST DR STE 155
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3359
Mailing Address - Country:US
Mailing Address - Phone:281-846-6844
Mailing Address - Fax:281-741-7786
Practice Address - Street 1:2901 WILCREST DR STE 155
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3359
Practice Address - Country:US
Practice Address - Phone:281-846-6844
Practice Address - Fax:281-741-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy