Provider Demographics
NPI:1770850521
Name:HOPE PROFESSIONAL COMPOUNDING PHARMACY INC
Entity Type:Organization
Organization Name:HOPE PROFESSIONAL COMPOUNDING PHARMACY INC
Other - Org Name:HOPE PROFESSIONAL COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-693-4673
Mailing Address - Street 1:1642 S MASON RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-4563
Mailing Address - Country:US
Mailing Address - Phone:281-693-4673
Mailing Address - Fax:281-693-4671
Practice Address - Street 1:1642 S MASON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-4563
Practice Address - Country:US
Practice Address - Phone:281-693-4673
Practice Address - Fax:281-693-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277153336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5905104OtherNCPDP PROVIDER IDENTIFICATION NUMBER