Provider Demographics
NPI:1881021871
Name:EXECUTIVE ENTERPRISES
Entity type:Organization
Organization Name:EXECUTIVE ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALRAZZAQ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:346-224-2125
Mailing Address - Street 1:9303 PINECROFT DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:346-224-2125
Mailing Address - Fax:346-224-2143
Practice Address - Street 1:9303 PINECROFT DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:346-224-2125
Practice Address - Fax:346-224-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287243336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy