Provider Demographics
NPI:1124328034
Name:MEDRX COMPOUNDING & PHARMACY LIMITED COMPANY
Entity type:Organization
Organization Name:MEDRX COMPOUNDING & PHARMACY LIMITED COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARPONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-259-1362
Mailing Address - Street 1:601 WAYSIDE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011-3614
Mailing Address - Country:US
Mailing Address - Phone:832-767-5466
Mailing Address - Fax:832-582-7795
Practice Address - Street 1:601 WAYSIDE DR STE D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-3614
Practice Address - Country:US
Practice Address - Phone:832-767-5466
Practice Address - Fax:832-582-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336S0011X
TX272353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5901776OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX148209Medicaid