Provider Demographics
NPI:1093833881
Name:BENDY B POOLE
Entity Type:Organization
Organization Name:BENDY B POOLE
Other - Org Name:CENTRAL DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:361-575-4713
Mailing Address - Street 1:1214 E MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2141
Mailing Address - Country:US
Mailing Address - Phone:361-575-4713
Mailing Address - Fax:361-573-9880
Practice Address - Street 1:1214 E MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2141
Practice Address - Country:US
Practice Address - Phone:361-575-4713
Practice Address - Fax:361-573-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16589333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143357Medicaid
TX143357Medicaid