Organization
IMMUNOVAX
Active
Other names
Travelvax Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ADAMS (OWNER)
(832) 460-9003
Entity
Organization
Contact information
Practice address
14655 NORTHWEST FWY STE 101, HOUSTON, TX 77040-4032
(832) 460-9003
(713) 939-1221
Mailing address
14655 NORTHWEST FWY STE 101, HOUSTON, TX 77040-4032
(832) 460-9003
(713) 939-1221
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
27662
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2132868
PK
—
Enumeration date
12/02/2011
Last updated
09/17/2014
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