Organization
POWERHOUSE PHARMACY RX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KUMUDBEN SHAHIWALA (OWNER)
(614) 886-0786
Entity
Organization
Contact information
Practice address
4740 W MOCKINGBIRD LN STE 100B, DALLAS, TX 75209-5208
(214) 350-2900
(214) 350-2904
Mailing address
4740 W MOCKINGBIRD LN STE 100B, DALLAS, TX 75209-5208
(214) 350-2900
(214) 350-2904
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
TX
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149825
—
TX
01
—
31863
PROVIDER LICENSE NUMBER
TX
Enumeration date
02/13/2018
Last updated
09/11/2024
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