Provider Demographics
NPI:1659143683
Name:PPC RX PHARMACY LLC
Entity Type:Organization
Organization Name:PPC RX PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LACHARRO
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-915-0554
Mailing Address - Street 1:2300 GREEN OAK DR STE 550
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2048
Mailing Address - Country:US
Mailing Address - Phone:832-915-0554
Mailing Address - Fax:832-430-4524
Practice Address - Street 1:2300 GREEN OAK DR STE 550
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2048
Practice Address - Country:US
Practice Address - Phone:832-915-0554
Practice Address - Fax:832-430-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy