Provider Demographics
NPI:1073091799
Name:BHAUMIK DIVERSIFIED LLC
Entity Type:Organization
Organization Name:BHAUMIK DIVERSIFIED LLC
Other - Org Name:TEXAS STAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASENJIT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BHAUMIK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:972-519-8475
Mailing Address - Street 1:3033 W PARKER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-8000
Mailing Address - Country:US
Mailing Address - Phone:972-519-8475
Mailing Address - Fax:
Practice Address - Street 1:3033 W PARKER RD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-8000
Practice Address - Country:US
Practice Address - Phone:972-519-8475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy