Provider Demographics
NPI:1689217069
Name:MACE CARE PHARMACY LLC
Entity type:Organization
Organization Name:MACE CARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-247-0903
Mailing Address - Street 1:6306 GULFTON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1117
Mailing Address - Country:US
Mailing Address - Phone:832-925-7033
Mailing Address - Fax:832-962-8538
Practice Address - Street 1:6306 GULFTON ST STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1117
Practice Address - Country:US
Practice Address - Phone:832-925-7033
Practice Address - Fax:832-962-8538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150215Medicaid