=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730161738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BGS PHARMACY PARTNERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2005
-----------------------------------------------------
Last Update Date | 06/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 WILLIAM D TATE AVE STE 200 STE 200
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-8734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-251-8073
-----------------------------------------------------
Fax | 817-552-1224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 WILLIAM D TATE AVE STE 200
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-8749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-251-8073
-----------------------------------------------------
Fax | 817-552-1224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | BRAD LANHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-328-6421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 24303
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------