Provider Demographics
NPI:1669575700
Name:EAST TEXAS CLINICAL SERVICES, INC
Entity type:Organization
Organization Name:EAST TEXAS CLINICAL SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC, RPH.
Authorized Official - Prefix:
Authorized Official - First Name:LEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-312-8590
Mailing Address - Street 1:22710 PROFESSIONAL DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-312-8590
Mailing Address - Fax:281-312-8594
Practice Address - Street 1:22710 PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-312-8590
Practice Address - Fax:281-312-8594
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST TEXAS CLINICAL SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX314563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2174277OtherPK