Organization
SSRX LLC
Active
Other names
SSRX Pharmacy 3, Southside Pharmacy 3
Organization subpart
No
Provider details
NPI number
Authorized official
MARK FETCENKO (COO-OFFICER)
(832) 533-1301
Entity
Organization
Contact information
Practice address
6330 WEST LOOP SOUTH, STE. 700 C, BELLAIRE, TX 77401-2928
(832) 553-1374
(855) 822-7838
Mailing address
6330 WEST LOOP SOUTH, STE. 700, BELLAIRE, TX 77401-2928
(832) 553-1374
(855) 822-7838
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
26659
TX
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146091
—
TX
05
—
149772
—
TX
01
—
2122749
PK
—
01
—
33989
TEXAS STATE BOARD OF PHARMACY LICENSE
TX
Enumeration date
11/13/2009
Last updated
03/16/2022
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