Provider Demographics
NPI:1932286804
Name:MED PHARMACY
Entity Type:Organization
Organization Name:MED PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-952-0505
Mailing Address - Street 1:7447 HARWIN DR
Mailing Address - Street 2:STE C-1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7447 HARWIN DR
Practice Address - Street 2:STE C-1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2016
Practice Address - Country:US
Practice Address - Phone:713-952-0505
Practice Address - Fax:713-952-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24131333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145549Medicaid
4536403OtherOTHER ID NUMBER-COMMERCIAL NUMBER