Individual
BA CAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1635 NORTH LOOP W, HOUSTON, TX 77008-1532
(713) 867-4498
Mailing address
4135 LEVONSHIRE DR, HOUSTON, TX 77025-3914
(713) 370-8031
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
23493
TX
Other
Enumeration date
06/05/2014
Last updated
06/05/2014
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