Provider Demographics
NPI:1932486800
Name:MAS PHARMACY RX LLC
Entity Type:Organization
Organization Name:MAS PHARMACY RX LLC
Other - Org Name:MAS PHARMACY RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-724-2194
Mailing Address - Street 1:PO BOX 5734
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77491-5734
Mailing Address - Country:US
Mailing Address - Phone:713-465-6113
Mailing Address - Fax:713-465-6119
Practice Address - Street 1:9355 LONG POINT RD STE L
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4481
Practice Address - Country:US
Practice Address - Phone:713-465-6113
Practice Address - Fax:713-465-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX276433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132557OtherPK