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General NPI Number Information
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NPI Number | 1104121235
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Entity Type | Organization
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Legal Business Name | BEAR CREEK PHARMACY LLC
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Dates
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Enumeration Date | 01/20/2011
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 101 BEAR CREEK PKWY STE B
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City | KELLER
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State | TX
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Zip | 76248-2531
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Country | US
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Telephone | 817-562-4766
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Fax | 817-562-4871
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Provider Business Mailing Address
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Address Line | 101 BEAR CREEK PKWY STE B
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City | KELLER
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State | TX
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Zip | 76248-2531
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Country | US
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Telephone | 817-562-4766
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Fax | 817-562-4871
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Authorized Official
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Title or Position | OWNER/PIC
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Name | HENRY SIMO
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Credential |
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Telephone | 817-562-4766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 27405
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License Number State | TX
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