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General NPI Number Information
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NPI Number | 1215972435
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Entity Type | Organization
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Legal Business Name | PBG INC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 203 RAILROAD ST BUILD 2 STE B
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City | BUDA
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State | TX
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Zip | 78610-3383
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Country | US
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Telephone | 512-312-2111
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Fax | 512-295-8300
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Provider Business Mailing Address
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Address Line | 203 RAILROAD ST BUILD 2 STE B
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City | BUDA
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State | TX
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Zip | 78610-3383
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Country | US
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Telephone | 512-312-2111
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Fax | 512-295-8300
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Authorized Official
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Title or Position | OWNER
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Name | TAMMY GRAY
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Credential | RPH
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Telephone | 512-913-3480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 24956
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License Number State | TX
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