Basic Information
| Provider Information | |||||||||
| NPI: | 1891971222 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TEXAS CHILDREN'S HOSPTIAL PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6621 FANNIN ST STE WB1120 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328241000 | ||||||||
| FaxNumber: | 8328255261 | ||||||||
| Practice Location | |||||||||
| Address1: | 6621 FANNIN ST STE WB1120 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328241000 | ||||||||
| FaxNumber: | 8328255261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 12/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | GAGE | ||||||||
| AuthorizedOfficialFirstName: | WELDON | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VP, CFO | ||||||||
| AuthorizedOfficialTelephone: | 8328241000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TEXAS CHILDREN'S HOSPITAL | ||||||||
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| NPICertificationDate: | 12/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | 000117 | TX | N | Hospitals | General Acute Care Hospital | Children | 3336C0002X | N | Suppliers | Pharmacy | Clinic Pharmacy | 3336C0003X | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0004X | N | Suppliers | Pharmacy | Compounding Pharmacy | 3336S0011X | N | Suppliers | Pharmacy | Specialty Pharmacy | 3336I0012X | Y | Suppliers | Pharmacy | Institutional Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 452333 | 01 | TX | MEDICARE | OTHER | 251034 | 05 | TX | MEDICAID | HH0222 | 01 | TX | BCBS | OTHER | 250304 | 05 | TX | MEDICAID | 453304 | 01 | TX | MEDICARE | OTHER |