Provider Demographics
NPI:1912553348
Name:HAZEL'S COMPUNDING RX PHARMACY
Entity Type:Organization
Organization Name:HAZEL'S COMPUNDING RX PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:713-340-0202
Mailing Address - Street 1:1801 COUNTRY PLACE PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5121
Mailing Address - Country:US
Mailing Address - Phone:713-340-0202
Mailing Address - Fax:713-340-0203
Practice Address - Street 1:1801 COUNTRY PLACE PKWY STE 115
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5121
Practice Address - Country:US
Practice Address - Phone:713-340-0202
Practice Address - Fax:713-340-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy