Provider Demographics
NPI:1275833063
Name:MEDICINE CABINET SM LLC
Entity Type:Organization
Organization Name:MEDICINE CABINET SM LLC
Other - Org Name:MEDICINE CABINET SM, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-779-4300
Mailing Address - Street 1:7419 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1901
Mailing Address - Country:US
Mailing Address - Phone:713-779-4300
Mailing Address - Fax:713-779-4303
Practice Address - Street 1:7419 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1901
Practice Address - Country:US
Practice Address - Phone:713-779-4300
Practice Address - Fax:713-779-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX271253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5901524OtherNCPDP PROVIDER IDENTIFICATION NUMBER