Provider Demographics
NPI:1538878517
Name:AMDEL ENTERPRISE LLC
Entity type:Organization
Organization Name:AMDEL ENTERPRISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PIC
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ONYINYE
Authorized Official - Last Name:AMUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-561-1422
Mailing Address - Street 1:17322 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4133
Mailing Address - Country:US
Mailing Address - Phone:281-725-9205
Mailing Address - Fax:281-525-4950
Practice Address - Street 1:17322 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4133
Practice Address - Country:US
Practice Address - Phone:281-725-9205
Practice Address - Fax:281-525-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150480Medicaid