Provider Demographics
NPI:1174705354
Name:EUMANA HOME DIALYSIS INC
Entity type:Organization
Organization Name:EUMANA HOME DIALYSIS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:MANNAN
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-660-8888
Mailing Address - Street 1:1313 LA CONCHA LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1809
Mailing Address - Country:US
Mailing Address - Phone:713-668-2744
Mailing Address - Fax:713-795-5959
Practice Address - Street 1:1313 LA CONCHA LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1809
Practice Address - Country:US
Practice Address - Phone:713-668-2744
Practice Address - Fax:713-795-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17448OtherSTATE LICENSE