Provider Demographics
NPI:1073910089
Name:NIGRO DERMATOLOGY GROUP, P.A.
Entity Type:Organization
Organization Name:NIGRO DERMATOLOGY GROUP, P.A.
Other - Org Name:WEST AVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-795-8800
Mailing Address - Street 1:7700 SAN FELIPE ST STE 492
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1630
Mailing Address - Country:US
Mailing Address - Phone:832-831-9480
Mailing Address - Fax:832-831-9481
Practice Address - Street 1:7700 SAN FELIPE ST STE 492
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1630
Practice Address - Country:US
Practice Address - Phone:832-831-9480
Practice Address - Fax:832-831-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX294183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy