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Organization
JERSEY VILLAGE PHARMACY LLC
Active
Organization
JERSEY VILLAGE PHARMACY LLC
Active
Other names
Jersey Village Pharmacy-Compounding
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE COON (PHARMACY MANAGER)
(713) 885-2039
Entity
Organization
Contact information
Practice address
17400 HIGHWAY 290 STE 400, JERSEY VILLAGE, TX 77040-1002
(281) 416-5800
(281) 416-5814
Mailing address
17400 HIGHWAY 290 STE 400, JERSEY VILLAGE, TX 77040-1002
(281) 416-5800
(281) 416-5814
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
28723
TX
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2142464
PK
—
Enumeration date
10/14/2013
Last updated
10/26/2013
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