Provider Demographics
NPI:1265846547
Name:BIZMART PHARMACY II
Entity Type:Organization
Organization Name:BIZMART PHARMACY II
Other - Org Name:BIZMART PHARMACY II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GHEBREMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-465-2300
Mailing Address - Street 1:779 NORMANDY ST STE 130A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3599
Mailing Address - Country:US
Mailing Address - Phone:832-767-2438
Mailing Address - Fax:832-767-2507
Practice Address - Street 1:779 NORMANDY ST STE 130A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3599
Practice Address - Country:US
Practice Address - Phone:832-767-2438
Practice Address - Fax:832-767-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146270OtherPK