Provider Demographics
NPI:1912400243
Name:PHARM HOUSE DRUG-LAVERNIA LLC
Entity Type:Organization
Organization Name:PHARM HOUSE DRUG-LAVERNIA LLC
Other - Org Name:PHARM HOUSE DRUG - LA VERNIA, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-203-9704
Mailing Address - Street 1:13857 US HWY 87 W STE 100
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121
Mailing Address - Country:US
Mailing Address - Phone:830-779-2219
Mailing Address - Fax:830-253-8908
Practice Address - Street 1:13857 US HIGHWAY 87 W
Practice Address - Street 2:SUITE 100
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-5919
Practice Address - Country:US
Practice Address - Phone:830-779-2219
Practice Address - Fax:830-253-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX318953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176678OtherPK