Provider Demographics
NPI:1750323325
Name:ELLA-MED INC
Entity Type:Organization
Organization Name:ELLA-MED INC
Other - Org Name:ELLA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-956-1622
Mailing Address - Street 1:3444 ELLA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-6100
Mailing Address - Country:US
Mailing Address - Phone:713-956-1622
Mailing Address - Fax:713-956-5944
Practice Address - Street 1:3444 ELLA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-6100
Practice Address - Country:US
Practice Address - Phone:713-956-1622
Practice Address - Fax:713-956-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX243313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4539497OtherNCPDP PROVIDER IDENTIFICATION NUMBER