Provider Demographics
NPI:1760866339
Name:PROTEX PHARMACY LLC
Entity Type:Organization
Organization Name:PROTEX PHARMACY LLC
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MALE
Authorized Official - Phone:713-632-3305
Mailing Address - Street 1:1540 KENFOREST DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2165
Mailing Address - Country:US
Mailing Address - Phone:713-632-3305
Mailing Address - Fax:
Practice Address - Street 1:1540 KENFOREST DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-2165
Practice Address - Country:US
Practice Address - Phone:713-632-3305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00OtherPHARMACY
TX00Medicaid