Provider Demographics
NPI:1275576530
Name:NEW ERA PHARMACY LLC
Entity Type:Organization
Organization Name:NEW ERA PHARMACY LLC
Other - Org Name:NEW ERA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC,MEMBER,AO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-342-4885
Mailing Address - Street 1:PO BOX 271120
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75027-1120
Mailing Address - Country:US
Mailing Address - Phone:214-942-7300
Mailing Address - Fax:214-942-7302
Practice Address - Street 1:9709 BRUTON RD
Practice Address - Street 2:STE 900
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-2704
Practice Address - Country:US
Practice Address - Phone:214-942-7300
Practice Address - Fax:214-942-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX243783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145589Medicaid
2098748OtherPK