Organization
TRUONG PHAN ENTERPRISE LLC
Active
Organization
TRUONG PHAN ENTERPRISE LLC
Active
Other names
COUNTRY PLACE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CHAU PHAN (PRESIDENT)
(832) 524-5427
Entity
Organization
Contact information
Practice address
2404 SMITH RANCH RD STE 100, PEARLAND, TX 77584-5233
(713) 436-3344
(713) 436-3803
Mailing address
11011 HUNDRED BRIDGE LN, SUGAR LAND, TX 77498-7229
(713) 436-3344
(713) 436-3803
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
25799
TX
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145559
—
TX
01
—
4537897
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/20/2006
Last updated
09/12/2012
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