Provider Demographics
NPI:1689932568
Name:ST HOPE FOUNDATION INC
Entity Type:Organization
Organization Name:ST HOPE FOUNDATION INC
Other - Org Name:ST. HOPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAM-COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-778-1300
Mailing Address - Street 1:6200 SAVOY DR
Mailing Address - Street 2:SUITE 540
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3300
Mailing Address - Country:US
Mailing Address - Phone:713-778-1300
Mailing Address - Fax:
Practice Address - Street 1:1414 S FRAZIER ST STE 105
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-4475
Practice Address - Country:US
Practice Address - Phone:936-494-2455
Practice Address - Fax:877-712-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX280153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134933OtherPK