Basic Information
| Provider Information | |||||||||
| NPI: | 1134774037 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TEXAS CHILDREN'S HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TEXAS CHILDREN'S PHARMACY - THE WOODLANDS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 HOLCOMBE BLVD STE 34L | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770212041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328283660 | ||||||||
| FaxNumber: | 8328259580 | ||||||||
| Practice Location | |||||||||
| Address1: | 17600 I-45 SOUTH | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9362675357 | ||||||||
| FaxNumber: | 8328259580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2019 | ||||||||
| LastUpdateDate: | 12/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | GAGE | ||||||||
| AuthorizedOfficialFirstName: | WELDON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8328241000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0004X | N | Suppliers | Pharmacy | Compounding Pharmacy | 3336I0012X | Y | Suppliers | Pharmacy | Institutional Pharmacy |
No ID Information.