Provider Demographics
NPI:1073617593
Name:BAYLOR UNIV HEALTH CENTER PHARMACY
Entity Type:Organization
Organization Name:BAYLOR UNIV HEALTH CENTER PHARMACY
Other - Org Name:BAYLOR UNIVERSITY HLTH CTR PHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:254-710-4268
Mailing Address - Street 1:209 SPEIGHT AVE
Mailing Address - Street 2:STE 214
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-1507
Mailing Address - Country:US
Mailing Address - Phone:254-710-4268
Mailing Address - Fax:254-710-3620
Practice Address - Street 1:209 SPEIGHT AVE
Practice Address - Street 2:STE 214
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1507
Practice Address - Country:US
Practice Address - Phone:254-710-4991
Practice Address - Fax:254-710-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4543535OtherOTHER ID NUMBER