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General NPI Number Information
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NPI Number | 1932323342
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Entity Type | Organization
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Legal Business Name | BROADWAY DRUG STORE INC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2027 BROADWAY ST
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City | GALVESTON
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State | TX
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Zip | 77550-4635
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Country | US
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Telephone | 409-765-7701
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Fax | 409-762-2545
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Provider Business Mailing Address
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Address Line | 2027 BROADWAY ST
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City | GALVESTON
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State | TX
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Zip | 77550-4635
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Country | US
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Telephone | 409-765-7701
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Fax | 409-762-2545
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Authorized Official
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Title or Position | OWNER
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Name | RITA WILLIAMSON
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Credential |
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Telephone | 409-765-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 01868
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License Number State | TX
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