MEDICARE: BRAZOS VALLEY HEMATOLOGY ONCOLOGY ASSOCIATES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1952920076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAZOS VALLEY HEMATOLOGY ONCOLOGY ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	2435 HARVEY MITCHELL PKWY S
Second Line	:	SUITE 120
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845
Country	:	US
Telephone Number	:	979-977-0193
Fax Number	:	866-733-2572

Provider Business Practice Location Address
First Line	:	2435 HARVEY MITCHELL PKWY S
Second Line	:	SUITE 120
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845
Country	:	US
Telephone Number	:	979-977-0193
Fax Number	:	866-733-2572

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	CRYSTAL FAIR
Credential	:	PHARMD
Telephone Number	:	979-977-0193

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	02/02/2026

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