Individual provider Active NPI

Demontrion Cordero Peters, PHARM D

  • Community/Retail Pharmacy
  • Houston, TX
National Provider Identifier
1295315406
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
33718 Issued in TX
Practice address
2909 Hillcroft St Ste 602
Houston, TX 77057-5847
Phone
(713) 289-4825
Fax
(281) 720-5131
NPI assigned
Apr 12, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 33718 TX Primary

Addresses

Primary practice location

2909 Hillcroft St Ste 602
Houston, TX 77057-5847

Mailing address

2909 Hillcroft St Ste 602
Houston, TX 77057-5847
Phone (713) 289-4825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
33718TXMDCommunity/Retail Pharmacy

Practice roles

OrganizationSpecialtyStatusNew patients
United Texan Pharmacy Community/Retail Pharmacy CurrentSince Apr 1, 2021 Accepting new patients

Locations

2909 Hillcroft Ave
Ste 602
Houston, TX 77057
Phone (281) 888-4139

10039 Bissonnet St
Ste 321
Houston, TX 77036
Phone (281) 313-5228

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1295315406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2909 HILLCROFT ST STE 602",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770575847",
            "telephone_number": "713-289-4825",
            "fax_number": "281-720-5131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2909 HILLCROFT ST STE 602",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770575847",
            "telephone_number": "713-289-4825",
            "fax_number": "281-720-5131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "DEMONTRION",
        "middle_name": "CORDERO",
        "credential": "PHARM D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-12",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "33718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.