Provider Demographics
NPI:1487954830
Name:CHAMPS PHARMACY
Entity type:Organization
Organization Name:CHAMPS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIOLLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-782-2900
Mailing Address - Street 1:6300 RICHMOND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5927
Mailing Address - Country:US
Mailing Address - Phone:713-782-2900
Mailing Address - Fax:713-782-2916
Practice Address - Street 1:6300 RICHMOND AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5927
Practice Address - Country:US
Practice Address - Phone:713-782-2900
Practice Address - Fax:713-782-2916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX271083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5901548OtherNCPDP PROVIDER IDENTIFICATION NUMBER