Provider Demographics
NPI:1659683480
Name:MFSB, INC.
Entity Type:Organization
Organization Name:MFSB, INC.
Other - Org Name:WILLOW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-443-8528
Mailing Address - Street 1:5922 BEECH DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-2735
Mailing Address - Country:US
Mailing Address - Phone:936-443-8528
Mailing Address - Fax:
Practice Address - Street 1:2102 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-8024
Practice Address - Country:US
Practice Address - Phone:713-677-0501
Practice Address - Fax:713-677-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5900623OtherNCPDP