Provider Demographics
NPI:1386762615
Name:FONDREN PHARMACY
Entity type:Organization
Organization Name:FONDREN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LORANDA
Authorized Official - Middle Name:LATONYA
Authorized Official - Last Name:HELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-773-1477
Mailing Address - Street 1:9600 FONDREN RD STE B3
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-3682
Mailing Address - Country:US
Mailing Address - Phone:713-773-1477
Mailing Address - Fax:713-773-1211
Practice Address - Street 1:9600 FONDREN RD STE B3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-3682
Practice Address - Country:US
Practice Address - Phone:713-773-1477
Practice Address - Fax:713-773-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145266Medicaid