Provider Demographics
NPI:1710567946
Name:ENZO HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ENZO HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:III
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:866-234-3696
Mailing Address - Street 1:2600 S LOOP W STE 300K
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2606
Mailing Address - Country:US
Mailing Address - Phone:866-234-3696
Mailing Address - Fax:
Practice Address - Street 1:2600 S LOOP W STE 300K
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2606
Practice Address - Country:US
Practice Address - Phone:866-234-3696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty