Provider Demographics
NPI:1841006111
Name:WALLER RX PHARMACY, PLLC
Entity type:Organization
Organization Name:WALLER RX PHARMACY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNIOUS
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:713-725-2211
Mailing Address - Street 1:31303 FM 2920 RD STE H
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-8196
Mailing Address - Country:US
Mailing Address - Phone:713-725-2211
Mailing Address - Fax:
Practice Address - Street 1:31303 FM 2920 RD STE H
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-8196
Practice Address - Country:US
Practice Address - Phone:713-725-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy