Provider Demographics
NPI:1891971222
Name:TEXAS CHILDREN'S HOSPTIAL PHARMACY
Entity Type:Organization
Organization Name:TEXAS CHILDREN'S HOSPTIAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:WELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-824-1000
Mailing Address - Street 1:6621 FANNIN ST STE WB1120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2369
Mailing Address - Country:US
Mailing Address - Phone:832-824-1000
Mailing Address - Fax:832-825-5261
Practice Address - Street 1:6621 FANNIN ST STE WB1120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2369
Practice Address - Country:US
Practice Address - Phone:832-824-1000
Practice Address - Fax:832-825-5261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS CHILDREN'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-16
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000117282NC2000X
3336C0002X, 3336C0003X, 3336C0004X, 3336I0012X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX452333OtherMEDICARE
TX251034Medicaid
TXHH0222OtherBCBS
TX250304Medicaid
TX453304OtherMEDICARE