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General NPI Number Information
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NPI Number | 1700458213
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Entity Type | Organization
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Legal Business Name | BULLDOG PHARMACY, LLC
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 115 N HOUSTON ST
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City | EDGEWOOD
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State | TX
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Zip | 75117-2502
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Country | US
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Telephone | 903-385-1122
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | GRAND SALINE
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State | TX
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Zip | 75140-0187
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Country | US
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Telephone | 903-385-1122
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Fax | 903-385-1124
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Authorized Official
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Title or Position | OWNER/PIC
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Name | DR. HOLLY RENEE RANDOLPH
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Credential | PHARMD, RPH
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Telephone | 903-385-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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