Provider Demographics
NPI:1013351972
Name:TEXAN PHARMACY LLC
Entity Type:Organization
Organization Name:TEXAN PHARMACY LLC
Other - Org Name:FREEPORT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KORDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-900-6283
Mailing Address - Street 1:323 S BRAZOSPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:77541-4506
Mailing Address - Country:US
Mailing Address - Phone:979-871-9189
Mailing Address - Fax:979-871-9257
Practice Address - Street 1:323 S BRAZOSPORT BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-4506
Practice Address - Country:US
Practice Address - Phone:979-871-9189
Practice Address - Fax:979-871-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX285183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140008OtherPK