Provider Demographics
NPI:1427638428
Name:UNITED TEXAN PHARMACY
Entity type:Organization
Organization Name:UNITED TEXAN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMONTRION
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:713-289-4825
Mailing Address - Street 1:2909 HILLCROFT ST STE 602
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5847
Mailing Address - Country:US
Mailing Address - Phone:281-888-4139
Mailing Address - Fax:
Practice Address - Street 1:2909 HILLCROFT ST STE 602
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5847
Practice Address - Country:US
Practice Address - Phone:281-888-4139
Practice Address - Fax:281-720-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33718OtherTEXAS STATE BOARD OF PHARMACY LICENSE