Idapco Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

27357 Issued in TX

Legal business name

IDAPCO INC

Doing business as

Medi Pro International Pharmacy

Practice address

11811 Fallbrook Dr Ste B3
Houston, TX 77065-3507

Phone

(281) 277-0111

Fax

(281) 277-0130

NPI assigned

Nov 4, 2010

Organization subpart

No

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

Authorized official

Name

Fatha Elmi

Title

Owner

Phone

(281) 277-0111

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Medi Pro International Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

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

{
    "created_epoch": "1288828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672963200000",
    "number": "1417258690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11811 FALLBROOK DR STE B3",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770653507",
            "telephone_number": "281-277-0111",
            "fax_number": "281-277-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11811 FALLBROOK DR STE B3",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770653507",
            "telephone_number": "281-277-0111",
            "fax_number": "281-277-0130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAPCO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-04",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A",
        "authorized_official_last_name": "ELMI",
        "authorized_official_first_name": "FATHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "281-277-0111"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "27357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2127170",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146345",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medi Pro International Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medi Pro International Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Houston, TX
• Providers in Houston, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.