Provider Demographics
NPI:1134626997
Name:PERSONALMED
Entity type:Organization
Organization Name:PERSONALMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY NETWORK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-776-3854
Mailing Address - Street 1:10370 RICHMOND AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4141
Mailing Address - Country:US
Mailing Address - Phone:281-776-3854
Mailing Address - Fax:
Practice Address - Street 1:10370 RICHMOND AVE STE 230
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4141
Practice Address - Country:US
Practice Address - Phone:281-776-3854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONALMED LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0004X
TX31744333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy