Provider Demographics
NPI:1487812426
Name:KP PROFESSIONAL PHARMACY
Entity type:Organization
Organization Name:KP PROFESSIONAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:SEKCHIU
Authorized Official - Last Name:KWONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:832-638-6866
Mailing Address - Street 1:PO BOX 16850
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6850
Mailing Address - Country:US
Mailing Address - Phone:832-638-6866
Mailing Address - Fax:
Practice Address - Street 1:5718 BELLAIRE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5506
Practice Address - Country:US
Practice Address - Phone:832-638-6866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23141333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23141OtherTEXAS PHARMACY LICENSE