Provider Demographics
NPI:1881912509
Name:PONDEROSA PHARMACY
Entity type:Organization
Organization Name:PONDEROSA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BLANZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:832-724-5091
Mailing Address - Street 1:1701 FM 1960 RD W STE M
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3213
Mailing Address - Country:US
Mailing Address - Phone:281-397-7001
Mailing Address - Fax:281-397-8490
Practice Address - Street 1:1701 FM 1960 RD W STE M
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3213
Practice Address - Country:US
Practice Address - Phone:281-397-7001
Practice Address - Fax:281-397-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy