Organization
PEP NIC & MIC LLC
Active
Organization
PEP NIC & MIC LLC
Active
Other names
Eastside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP PARKER (MANAGER)
(713) 771-1767
Entity
Organization
Contact information
Practice address
8449 W BELLFORT ST, STE 130, HOUSTON, TX 77071-2245
(713) 771-1767
(713) 771-1768
Mailing address
8204 ELMBROOK DR, SUITE 176, DALLAS, TX 75247-4067
(713) 771-1767
(713) 771-1768
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
24365
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145703
—
TX
01
—
4539500
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/11/2006
Last updated
08/27/2009
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up