Provider Demographics
NPI:1952993305
Name:MEMORIAL PHARMACY
Entity Type:Organization
Organization Name:MEMORIAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TETE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOFFIE-LARTEVI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:504-782-1733
Mailing Address - Street 1:3333 S ALAMEDA ST APT 13P
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1848
Mailing Address - Country:US
Mailing Address - Phone:504-782-1733
Mailing Address - Fax:
Practice Address - Street 1:7017 S STAPLES ST STE 103B
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5507
Practice Address - Country:US
Practice Address - Phone:504-782-1733
Practice Address - Fax:504-782-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy