Provider Demographics
NPI:1972768349
Name:KATY PHARMACY INC
Entity type:Organization
Organization Name:KATY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MILAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-599-7800
Mailing Address - Street 1:962 S FRY RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3062
Mailing Address - Country:US
Mailing Address - Phone:281-599-7800
Mailing Address - Fax:281-599-7814
Practice Address - Street 1:962 S FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3062
Practice Address - Country:US
Practice Address - Phone:281-599-7800
Practice Address - Fax:281-599-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260893336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4549006OtherNCPDP PROVIDER IDENTIFICATION NUMBER