Provider Demographics
NPI:1780924571
Name:DREAM PHARMACY INC
Entity type:Organization
Organization Name:DREAM PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASSAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSHEIKHKASSIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-465-1117
Mailing Address - Street 1:1140 BUSINESS CENTER DR
Mailing Address - Street 2:STE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2737
Mailing Address - Country:US
Mailing Address - Phone:713-465-1117
Mailing Address - Fax:713-465-1480
Practice Address - Street 1:1140 BUSINESS CENTER DR
Practice Address - Street 2:STE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2737
Practice Address - Country:US
Practice Address - Phone:713-465-1117
Practice Address - Fax:713-465-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146721Medicaid
2139022OtherPK