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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