Provider Demographics
NPI:1356585004
Name:LEADCARE PHARMACY INC
Entity type:Organization
Organization Name:LEADCARE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:AZUBUIKE
Authorized Official - Last Name:ANYADIKE
Authorized Official - Suffix:
Authorized Official - Credentials:B PHARM
Authorized Official - Phone:713-774-8180
Mailing Address - Street 1:9908 S GESSNER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-1008
Mailing Address - Country:US
Mailing Address - Phone:713-774-8180
Mailing Address - Fax:713-774-8181
Practice Address - Street 1:9908 S GESSNER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-1008
Practice Address - Country:US
Practice Address - Phone:713-774-8180
Practice Address - Fax:713-774-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX264423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146034Medicaid