Provider Demographics
NPI:1487965885
Name:PARAMOUNT PHARMACY LLC
Entity type:Organization
Organization Name:PARAMOUNT PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARAMBIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-217-5223
Mailing Address - Street 1:1304 S LOOP W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4010
Mailing Address - Country:US
Mailing Address - Phone:713-795-5888
Mailing Address - Fax:281-616-6226
Practice Address - Street 1:1304 S LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4010
Practice Address - Country:US
Practice Address - Phone:713-795-5888
Practice Address - Fax:281-616-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX269133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5900421OtherNCPDP PROVIDER IDENTIFICATION NUMBER