Organization
MAURICEVILLE PHARMACY LLC
Active
Other names
Mauriceville Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TREY HANEY (MANAGER)
(409) 769-2406
Entity
Organization
Contact information
Practice address
10897 HWY 12, MAURICEVILLE, TX 77626
(409) 745-3784
(409) 745-5910
Mailing address
PO BOX 1149, MAURICEVILLE, TX 77626-1149
(409) 745-3784
(409) 745-5910
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
23916
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149069
—
TX
01
—
2096486
PK
—
Enumeration date
06/11/2006
Last updated
09/09/2021
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