Healthcare Provider Details

I. General information

NPI: 1013740026
Provider Name (Legal Business Name): PBG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 RAILROAD ST STE 2B
BUDA TX
78610-3437
US

IV. Provider business mailing address

203 RAILROAD ST STE 2B
BUDA TX
78610-3437
US

V. Phone/Fax

Practice location:
  • Phone: 512-312-2111
  • Fax: 512-295-8300
Mailing address:
  • Phone: 512-312-2111
  • Fax: 512-295-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMMY GRAY
Title or Position: PHARMACIST-IN-CHARGE
Credential: RPH
Phone: 512-312-2111