Provider Demographics
NPI:1245543909
Name:SRB PHARMACY
Entity type:Organization
Organization Name:SRB PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:LES
Authorized Official - Middle Name:
Authorized Official - Last Name:PIENIAZEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:281-240-3308
Mailing Address - Street 1:12707 TRINITY ST
Mailing Address - Street 2:SUITE 177
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4212
Mailing Address - Country:US
Mailing Address - Phone:281-240-3308
Mailing Address - Fax:281-240-3308
Practice Address - Street 1:12707 TRINITY ST
Practice Address - Street 2:SUITE 177
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4212
Practice Address - Country:US
Practice Address - Phone:281-240-3308
Practice Address - Fax:281-240-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy