Provider Demographics
NPI:1821405556
Name:BAKER CYPRESS PHARMACY AND HOME CARE EQUIPMENT LLC
Entity type:Organization
Organization Name:BAKER CYPRESS PHARMACY AND HOME CARE EQUIPMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE/MANAGING OFFIC
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:KELECHI
Authorized Official - Last Name:OCHIAGHA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:713-631-3117
Mailing Address - Street 1:705 S FRY ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450
Mailing Address - Country:US
Mailing Address - Phone:713-631-3117
Mailing Address - Fax:713-631-3119
Practice Address - Street 1:705 S FRY ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:713-631-3117
Practice Address - Fax:713-631-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX293143336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146857OtherPK
TX147000Medicaid