Organization
SPACE CITY PHARMACY LLC
Active
Organization
SPACE CITY PHARMACY LLC
Active
Other names
Space City Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN MOORE (MANAGING MEMBER)
(832) 569-5062
Entity
Organization
Contact information
Practice address
902 S FRIENDSWOOD DR STE E, FRIENDSWOOD, TX 77546-5154
(832) 569-5062
(832) 569-5064
Mailing address
902 S FRIENDSWOOD DR STE E, FRIENDSWOOD, TX 77546-5154
(832) 569-5062
(832) 569-5064
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32841
PHARMACY LICENSE
TX
Enumeration date
09/04/2019
Last updated
07/19/2021
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