Provider Demographics
NPI:1952131906
Name:PHARM HOUSE DRUG-LAVERNIA LLC
Entity type:Organization
Organization Name:PHARM HOUSE DRUG-LAVERNIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-779-2219
Mailing Address - Street 1:13857 US HIGHWAY 87 W STE 100
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-5921
Mailing Address - Country:US
Mailing Address - Phone:830-779-2219
Mailing Address - Fax:830-253-8908
Practice Address - Street 1:13857 US HIGHWAY 87 W STE 100
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-5921
Practice Address - Country:US
Practice Address - Phone:830-779-2219
Practice Address - Fax:830-253-8908
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARM HOUSE DRUG - LA VERNIA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy