Provider Demographics
NPI:1710973482
Name:MEDCARE RX PHARMACY, INC
Entity Type:Organization
Organization Name:MEDCARE RX PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-272-9600
Mailing Address - Street 1:PO BOX 742089
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77274-2089
Mailing Address - Country:US
Mailing Address - Phone:713-272-9600
Mailing Address - Fax:713-272-9601
Practice Address - Street 1:7052 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-6010
Practice Address - Country:US
Practice Address - Phone:713-272-9600
Practice Address - Fax:713-272-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23264333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145404Medicaid
TX169115601Medicaid
TX4535754OtherNCPDP (PRESCRIPTION)
TX169115602Medicaid
TX269955OtherAMERIGROUP (DME)
TX169115602Medicaid