Organization
ENNIS STREET PHARMACY INC
Active
Other names
Ennis St. Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD MARTIN (PRESIDENT)
(713) 524-7600
Entity
Organization
Contact information
Practice address
4702 ENNIS ST, HOUSTON, TX 77004-6132
(713) 524-7600
(713) 524-7604
Mailing address
4702 ENNIS ST, HOUSTON, TX 77004-6132
(713) 524-7600
(713) 524-7604
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
26912
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125270
PK
—
Enumeration date
05/25/2010
Last updated
12/23/2015
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