Healthcare Provider Details

I. General information

NPI: 1750954103
Provider Name (Legal Business Name): BANCROFT STREET 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 FM 1103 STE 121
CIBOLO TX
78108-3673
US

IV. Provider business mailing address

791 FM 1103 STE 121
CIBOLO TX
78108-3673
US

V. Phone/Fax

Practice location:
  • Phone: 210-236-7700
  • Fax: 855-571-3571
Mailing address:
  • Phone: 210-236-7700
  • Fax: 855-571-3571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ABDULHAMID SALEH NASSOR
Title or Position: OWNER
Credential: PHARMD
Phone: 313-522-0605