Provider Demographics
NPI:1265733000
Name:MAINSTREAM PHARMACY LLC
Entity type:Organization
Organization Name:MAINSTREAM PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKWUNEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-210-8862
Mailing Address - Street 1:5720 BELLAIRE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5513
Mailing Address - Country:US
Mailing Address - Phone:713-660-8500
Mailing Address - Fax:713-931-6700
Practice Address - Street 1:5720 BELLAIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5513
Practice Address - Country:US
Practice Address - Phone:713-660-8500
Practice Address - Fax:713-931-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27239333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5901764OtherNCPDP PROVIDER IDENTIFICATION NUMBER