Provider Demographics
NPI:1679011415
Name:MEDICINE CHEST PLUS PHARMACY, LLC
Entity Type:Organization
Organization Name:MEDICINE CHEST PLUS PHARMACY, LLC
Other - Org Name:MEDICINE CHEST PLUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SWEATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-246-3350
Mailing Address - Street 1:15355 VANTAGE PKWY W STE 212
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-1974
Mailing Address - Country:US
Mailing Address - Phone:832-328-0923
Mailing Address - Fax:281-741-4578
Practice Address - Street 1:15355 VANTAGE PKWY W STE 212
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-1974
Practice Address - Country:US
Practice Address - Phone:832-328-0923
Practice Address - Fax:346-570-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31310OtherSTATE PHARMACY LICENSE
TX149599Medicaid