Provider Demographics
NPI:1841205481
Name:CARE FAMILY PHARMACY
Entity Type:Organization
Organization Name:CARE FAMILY PHARMACY
Other - Org Name:CARE FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-451-0202
Mailing Address - Street 1:1313 HOLLAND ST
Mailing Address - Street 2:STE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1313 HOLLAND ST
Practice Address - Street 2:STE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-2890
Practice Address - Country:US
Practice Address - Phone:713-451-0202
Practice Address - Fax:713-451-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24426333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145642Medicaid
4540325OtherOTHER ID NUMBER-COMMERCIAL NUMBER