Provider Demographics
NPI:1679584254
Name:KATY PROCARE PHARMACY LLC
Entity type:Organization
Organization Name:KATY PROCARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-8888
Mailing Address - Street 1:1331 W GRAND PKWY N STE 111
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2711
Mailing Address - Country:US
Mailing Address - Phone:832-437-8425
Mailing Address - Fax:832-437-9129
Practice Address - Street 1:1331 W GRAND PKWY N STE 111
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2711
Practice Address - Country:US
Practice Address - Phone:832-437-8425
Practice Address - Fax:832-437-9129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX296083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147022Medicaid
2144659OtherPK
5117320001Medicare NSC