Provider Demographics
NPI:1851107288
Name:NORTHSIDE PHARMACY LLC
Entity type:Organization
Organization Name:NORTHSIDE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHUNTELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-940-0424
Mailing Address - Street 1:5201 HARRISBURG BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011-4229
Mailing Address - Country:US
Mailing Address - Phone:832-940-0424
Mailing Address - Fax:824-940-0415
Practice Address - Street 1:5201 HARRISBURG BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-4229
Practice Address - Country:US
Practice Address - Phone:832-940-0424
Practice Address - Fax:824-940-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies