Organization
SOUTHERN TIER HOME INFUSION INC
Active
Other names
Pharmacy Innovations
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD MOON (PRESIDENT/OWNER)
(716) 720-5121
Entity
Organization
Contact information
Practice address
11301 RICHMOND AVE STE K101, HOUSTON, TX 77082-5550
(281) 497-5214
(281) 497-5215
Mailing address
2535 JOHNS PL, JAMESTOWN, NY 14701-9210
(716) 720-5121
(716) 708-6248
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28689
TX
3336C0004X
Compounding Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143155
PK
—
Enumeration date
11/25/2008
Last updated
07/13/2022
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