Provider Demographics
NPI:1306535307
Name:OPTIMAL BALANCE PHARMACY
Entity type:Organization
Organization Name:OPTIMAL BALANCE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-444-5027
Mailing Address - Street 1:15726 JERSEY DR
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77040-2146
Mailing Address - Country:US
Mailing Address - Phone:210-748-3260
Mailing Address - Fax:
Practice Address - Street 1:2204 CYPRESS CREEK PKWY STE F&G
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3113
Practice Address - Country:US
Practice Address - Phone:281-919-2964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy