Provider Demographics
NPI:1386965465
Name:HOUSTON, EDNA G (RPH)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:G
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 BANKS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6015
Mailing Address - Country:US
Mailing Address - Phone:713-529-2104
Mailing Address - Fax:713-664-2342
Practice Address - Street 1:5225 BUFFALO SPEEDWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-4210
Practice Address - Country:US
Practice Address - Phone:713-218-1850
Practice Address - Fax:713-664-2342
Is Sole Proprietor?:No
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist