MEDICARE: BROADWAY PHARMACY

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	28788	TX

General Provider Information

NPI Number	:	1811323454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADWAY PHARMACY

Provider Business Mailing Address
First Line	:	3744 BROADWAY ST
Second Line	:	C
City	:	HOUSTON
State	:	TX
Zip	:	77017-3046
Country	:	US
Telephone Number	:	832-885-7061
Fax Number	:	713-450-0028

Provider Business Practice Location Address
First Line	:	3744 BROADWAY ST
Second Line	:	C
City	:	HOUSTON
State	:	TX
Zip	:	77017-3046
Country	:	US
Telephone Number	:	832-885-7061
Fax Number	:	713-450-0028

Authorized Official
Title or Position	:	OWNER/PHARAMCIST
Name	:	DR. TAN DUY NGUYEN
Credential	:	PHARMD
Telephone Number	:	832-885-7061

Provider Enumeration Date	:	09/14/2013
Last Update Date	:	09/14/2013

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Directions to “BROADWAY PHARMACY ” Practice Location

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