Provider Demographics
NPI:1235646662
Name:BH-SD RX, LLC
Entity Type:Organization
Organization Name:BH-SD RX, LLC
Other - Org Name:4 FRONT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-254-2510
Mailing Address - Street 1:7200 PARKWAY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1534
Mailing Address - Country:US
Mailing Address - Phone:619-303-3574
Mailing Address - Fax:619-303-3623
Practice Address - Street 1:7200 PARKWAY DR STE 104
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1534
Practice Address - Country:US
Practice Address - Phone:619-303-3574
Practice Address - Fax:619-303-3623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy