Provider Demographics
NPI:1679028393
Name:SOUTHLAND HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:SOUTHLAND HEALTHCARE SERVICES INC
Other - Org Name:AJOY HEALTHCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-514-9494
Mailing Address - Street 1:5302 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011-2258
Mailing Address - Country:US
Mailing Address - Phone:713-514-9494
Mailing Address - Fax:713-514-9495
Practice Address - Street 1:5302 CANAL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-2258
Practice Address - Country:US
Practice Address - Phone:713-514-9494
Practice Address - Fax:713-514-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31013333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162304OtherPK