Provider Demographics
NPI:1619438975
Name:CREATIVE PHARMACY MGMT, LLC
Entity type:Organization
Organization Name:CREATIVE PHARMACY MGMT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DENNOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-471-6121
Mailing Address - Street 1:4705 AVENUE H STE C
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2065
Mailing Address - Country:US
Mailing Address - Phone:832-471-6121
Mailing Address - Fax:832-759-5763
Practice Address - Street 1:4705 AVENUE H STE C
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2065
Practice Address - Country:US
Practice Address - Phone:832-471-6121
Practice Address - Fax:832-759-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy