MEDICARE: Q3BL PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	31497	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5921817	OTHER	TX	NCPDP
2	31497	OTHER	TX	TEXAS STATE BOARD OF PHARMACY LICENSE

General Provider Information

NPI Number	:	1407373186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	Q3BL PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 3835
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77643-3835
Country	:	US
Telephone Number	:	409-985-8874
Fax Number	:	409-985-6568

Provider Business Practice Location Address
First Line	:	3250 CENTRAL MALL DR
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-8037
Country	:	US
Telephone Number	:	409-853-1685
Fax Number	:	409-853-1713

Authorized Official
Title or Position	:	OWNER/MGR
Name	:	MR. QUYNH JEFF PHAM
Credential	:
Telephone Number	:	409-985-8874

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	03/07/2023

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Directions to “Q3BL PHARMACY LLC ” Practice Location

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