Healthcare Provider Details

I. General information

NPI: 1386815660
Provider Name (Legal Business Name): BNC PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 DEMOSS STE 104C
HOUSTON TX
77074
US

IV. Provider business mailing address

6565 DEMOSS STE 104C
HOUSTON TX
77074
US

V. Phone/Fax

Practice location:
  • Phone: 713-773-3800
  • Fax: 713-773-3865
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number25931
License Number StateTX

VIII. Authorized Official

Name: CHIDEBEM NWOSU
Title or Position: MANG
Credential:
Phone: 713-773-3800