Provider Demographics
NPI:1285416255
Name:FILLCERA LLC
Entity type:Organization
Organization Name:FILLCERA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGEQ
Authorized Official - Prefix:
Authorized Official - First Name:WESAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:708-985-5485
Mailing Address - Street 1:1651 N COLLINS BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3681
Mailing Address - Country:US
Mailing Address - Phone:469-777-4669
Mailing Address - Fax:469-777-4668
Practice Address - Street 1:1651 N COLLINS BLVD STE 222
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3681
Practice Address - Country:US
Practice Address - Phone:469-777-4669
Practice Address - Fax:469-777-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy