Provider Demographics
NPI:1780723353
Name:HILLCROFT PLAZA PHARMACY INC.
Entity type:Organization
Organization Name:HILLCROFT PLAZA PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:WALLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:281-908-4541
Mailing Address - Street 1:6655 HILLCROFT ST
Mailing Address - Street 2:108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4815
Mailing Address - Country:US
Mailing Address - Phone:713-541-6655
Mailing Address - Fax:713-541-0052
Practice Address - Street 1:6655 HILLCROFT ST
Practice Address - Street 2:108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4815
Practice Address - Country:US
Practice Address - Phone:713-541-6655
Practice Address - Fax:713-541-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144178Medicaid
TX144178Medicaid