Provider Demographics
NPI:1063403806
Name:P.S.P ENTERPRISE INC
Entity type:Organization
Organization Name:P.S.P ENTERPRISE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAURABH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-869-3487
Mailing Address - Street 1:427 W 20TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2441
Mailing Address - Country:US
Mailing Address - Phone:713-869-3487
Mailing Address - Fax:713-869-0088
Practice Address - Street 1:427 W 20TH ST STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2441
Practice Address - Country:US
Practice Address - Phone:713-869-3487
Practice Address - Fax:713-869-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX152963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4587638OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX143901Medicaid