Provider Demographics
NPI:1659382141
Name:CITIZENS PHARMACY LLC
Entity Type:Organization
Organization Name:CITIZENS PHARMACY LLC
Other - Org Name:CITIZENS PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORISED OFFICIAL/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YAMINI
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-695-7316
Mailing Address - Street 1:17070 RED OAK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2615
Mailing Address - Country:US
Mailing Address - Phone:713-695-7316
Mailing Address - Fax:713-691-4133
Practice Address - Street 1:17070 RED OAK DR STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2615
Practice Address - Country:US
Practice Address - Phone:713-695-7316
Practice Address - Fax:713-691-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX067573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2101877OtherPK
TX150457Medicaid
TX148279Medicaid