Provider Demographics
NPI:1679759518
Name:HOUSTON PHYSICIANS MEDICAL ASSOCIATION P L L C
Entity Type:Organization
Organization Name:HOUSTON PHYSICIANS MEDICAL ASSOCIATION P L L C
Other - Org Name:PATIENT DIRECT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-364-8887
Mailing Address - Street 1:920 MEDICAL PLAZA DR
Mailing Address - Street 2:STE 140
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3260
Mailing Address - Country:US
Mailing Address - Phone:281-298-1129
Mailing Address - Fax:281-298-1168
Practice Address - Street 1:920 MEDICAL PLAZA DR
Practice Address - Street 2:STE 140
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3260
Practice Address - Country:US
Practice Address - Phone:281-298-1129
Practice Address - Fax:281-298-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4547139OtherNCPDP PROVIDER IDENTIFICATION NUMBER