Provider Demographics
NPI:1699511329
Name:KATY BOARDWALK PHARMACY INC
Entity type:Organization
Organization Name:KATY BOARDWALK PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMULUNDU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:281-377-1652
Mailing Address - Street 1:3120 SOUTHWEST FWY SUITE 101 PMB 419996
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098
Mailing Address - Country:US
Mailing Address - Phone:281-377-1652
Mailing Address - Fax:
Practice Address - Street 1:25230 KINGSLAND BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2097
Practice Address - Country:US
Practice Address - Phone:281-377-1652
Practice Address - Fax:281-377-3981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy