Provider Demographics
NPI:1538727847
Name:LIGHTCARE RX LLC
Entity type:Organization
Organization Name:LIGHTCARE RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-502-8009
Mailing Address - Street 1:8313 SOUTHWEST FWY STE 107
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1612
Mailing Address - Country:US
Mailing Address - Phone:832-987-1795
Mailing Address - Fax:832-599-7850
Practice Address - Street 1:8313 SOUTHWEST FWY STE 107
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1612
Practice Address - Country:US
Practice Address - Phone:832-987-1795
Practice Address - Fax:832-599-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-01
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150113Medicaid