Provider Demographics
NPI:1225104987
Name:BOWIE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BOWIE MEMORIAL HOSPITAL
Other - Org Name:RICKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:940-872-9374
Mailing Address - Street 1:705 E GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230
Mailing Address - Country:US
Mailing Address - Phone:940-872-9371
Mailing Address - Fax:940-872-1561
Practice Address - Street 1:705 E GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230
Practice Address - Country:US
Practice Address - Phone:940-872-9371
Practice Address - Fax:940-872-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4510093OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX0866130002Medicare NSC