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
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