Provider Demographics
NPI:1972854065
Name:UPSHAW PHARMACY
Entity Type:Organization
Organization Name:UPSHAW PHARMACY
Other - Org Name:UPSHAW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:OLUCHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OHANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-416-9123
Mailing Address - Street 1:7125 W FUQUA DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2451
Mailing Address - Country:US
Mailing Address - Phone:281-416-9123
Mailing Address - Fax:281-416-9129
Practice Address - Street 1:7125 W FUQUA DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-2451
Practice Address - Country:US
Practice Address - Phone:281-416-9123
Practice Address - Fax:281-416-9129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5907069OtherNCPDP PROVIDER IDENTIFICATION NUMBER