Organization
MIX IT RX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KECIA ANDERSON PHARMD (PHARMACIST-IN-CHARGE)
(612) 386-9483
Entity
Organization
Contact information
Practice address
4775 LEXINGTON BLVD, MISSOURI CITY, TX 77459-2801
(346) 341-7995
(346) 770-3157
Mailing address
4775 LEXINGTON BLVD, MISSOURI CITY, TX 77459-2801
(346) 341-7995
(346) 770-3157
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
691069
—
TX
Enumeration date
06/08/2020
Last updated
11/02/2020
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