Organization
DIABETES CENTER OF AMERICA PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA JOHNSON (CREDENTIALING COORDINATOR)
(713) 840-5245
Entity
Organization
Contact information
Practice address
11321 FALLBROOK DRIVE, HOUSTON, TX 77065-4232
(832) 237-3500
(832) 237-0200
Mailing address
11321 FALLBROOK DRIVE, HOUSTON, TX 77065-4232
(832) 237-3500
(832) 237-0200
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
800702863
TX
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1900326 02
—
TX
05
—
190032602
—
TX
Enumeration date
01/10/2008
Last updated
08/11/2009
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