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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