Organization
PROGRESSIVE PHARMA LLC
Active
Other names
Altus Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AMIR MORTAZAVI (AUTHORIZED OFFICAL)
(972) 432-6550
Entity
Organization
Contact information
Practice address
1535 WEST LOOP S, SUITE 322, HOUSTON, TX 77027-9512
(972) 432-6550
(214) 261-2217
Mailing address
5710 LBJ FWY, SUITE 325, DALLAS, TX 75240-6324
(972) 432-6550
(214) 261-2217
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
29069
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147410
PK
—
Enumeration date
09/15/2014
Last updated
01/12/2015
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