Organization
NORTHEAST COMPOUNDING PHCY LP
Active
Organization
NORTHEAST COMPOUNDING PHCY LP
Active
Other names
THRIFTY HLTH AND COMPOUNDING PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY MIELKE RPH (PIC)
(281) 446-9191
Entity
Organization
Contact information
Practice address
211 FM 1960 BYPASS RD E, HUMBLE, TX 77338-3605
(281) 446-9191
(281) 446-2329
Mailing address
211 FM 1960 BYPASS RD E, HUMBLE, TX 77338-3605
(281) 446-9191
(281) 446-2329
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
21404
TX
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145193 TX
—
TX
01
—
4563133
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/02/2007
Last updated
12/15/2011
Update your record
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