Provider Demographics
NPI:1134405269
Name:VPHARM CLINICAL CONSULTING SERVICES PLLC
Entity type:Organization
Organization Name:VPHARM CLINICAL CONSULTING SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE- CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIRAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-9920
Mailing Address - Street 1:PO BOX 20488
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77225-0488
Mailing Address - Country:US
Mailing Address - Phone:713-660-9920
Mailing Address - Fax:713-391-8436
Practice Address - Street 1:8990 KIRBY DR STE 240
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2854
Practice Address - Country:US
Practice Address - Phone:713-660-9920
Practice Address - Fax:713-391-8436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336L0003X, 333600000X
TX279813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149010Medicaid
2135026OtherPK