Provider Demographics
NPI:1982026811
Name:COMPREHENSIVE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE HEALTHCARE SERVICES LLC
Other - Org Name:THE FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUNADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-857-5510
Mailing Address - Street 1:3660 JOE BATTLE BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2628
Mailing Address - Country:US
Mailing Address - Phone:915-857-5510
Mailing Address - Fax:915-857-5505
Practice Address - Street 1:12371 EDGEMERE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4879
Practice Address - Country:US
Practice Address - Phone:915-857-5510
Practice Address - Fax:915-857-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336C0004X
TX288993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146883Medicaid
2143142OtherPK
TX146883Medicaid