Provider Demographics
NPI:1760613640
Name:DEERBROOK PHARMACY, LLC
Entity Type:Organization
Organization Name:DEERBROOK PHARMACY, LLC
Other - Org Name:DEERBROOK PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:281-967-1255
Mailing Address - Street 1:9816 MEMORIAL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4205
Mailing Address - Country:US
Mailing Address - Phone:281-446-0061
Mailing Address - Fax:281-446-1353
Practice Address - Street 1:9816 MEMORIAL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4205
Practice Address - Country:US
Practice Address - Phone:281-446-0061
Practice Address - Fax:281-446-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26650332B00000X
333600000X, 3336C0003X, 3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122452OtherPK
TX146076Medicaid
6853310001Medicare NSC