Provider Demographics
NPI:1659873214
Name:HOUSTON LIFE VENTURES, LLC
Entity Type:Organization
Organization Name:HOUSTON LIFE VENTURES, LLC
Other - Org Name:ALPHA OMEGA INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:281-201-2805
Mailing Address - Street 1:12865 CAPRICORN ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3915
Mailing Address - Country:US
Mailing Address - Phone:281-201-2805
Mailing Address - Fax:281-201-2826
Practice Address - Street 1:12865 CAPRICORN ST
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477
Practice Address - Country:US
Practice Address - Phone:281-201-2805
Practice Address - Fax:281-201-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31959251F00000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31959OtherTEXAS BOARD OF PHARMACY