Healthcare Provider Details

I. General information

NPI: 1902018088
Provider Name (Legal Business Name): BINGLE ROAD PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 BINGLE RD SUITE#107
HOUSTON TX
77092-1328
US

IV. Provider business mailing address

6401 BINGLE RD SUITE#107
HOUSTON TX
77092-1328
US

V. Phone/Fax

Practice location:
  • Phone: 713-939-9230
  • Fax: 713-939-9234
Mailing address:
  • Phone: 713-939-9230
  • Fax: 713-939-9234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number111417
License Number StateTX

VIII. Authorized Official

Name: MS. NIKESHA MARSHEA DIXON
Title or Position: OWNER
Credential:
Phone: 713-939-9230