Provider Demographics
NPI:1447728423
Name:PROVIDENCE PHARMACY & MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:PROVIDENCE PHARMACY & MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORUSAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-623-7554
Mailing Address - Street 1:9525 BISSONNET ST STE 250
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9525 BISSONNET ST STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8028
Practice Address - Country:US
Practice Address - Phone:832-623-7554
Practice Address - Fax:832-832-5693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy