Provider Demographics
NPI:1679965396
Name:ECO PHARMACY OF KATY WEST LLC
Entity Type:Organization
Organization Name:ECO PHARMACY OF KATY WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MAANGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-955-7500
Mailing Address - Street 1:19255 PARK ROW
Mailing Address - Street 2:STE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7309
Mailing Address - Country:US
Mailing Address - Phone:281-206-7388
Mailing Address - Fax:
Practice Address - Street 1:19255 PARK ROW
Practice Address - Street 2:STE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7309
Practice Address - Country:US
Practice Address - Phone:281-206-7388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization