Organization
FAIRWAY PHARMACY LLC
Active
Other names
Fairway Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MUSTAFA MUSSAJI (PHARMACIST)
(832) 630-6955
Entity
Organization
Contact information
Practice address
4912 TELEPHONE RD, HOUSTON, TX 77087-3504
(713) 454-0211
(713) 454-0224
Mailing address
4912 TELEPHONE RD, HOUSTON, TX 77087-3504
(713) 454-0211
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27154
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148681
—
TX
01
—
2126307
PK
—
Enumeration date
08/12/2010
Last updated
05/24/2021
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