Provider Demographics
NPI:1275671851
Name:BHP LAX LLC
Entity Type:Organization
Organization Name:BHP LAX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AO
Authorized Official - Prefix:
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-804-4735
Mailing Address - Street 1:1228 COLONIAL COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2215
Mailing Address - Country:US
Mailing Address - Phone:803-286-8444
Mailing Address - Fax:803-286-8466
Practice Address - Street 1:1228 COLONIAL COMMONS CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2215
Practice Address - Country:US
Practice Address - Phone:803-286-8444
Practice Address - Fax:803-286-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
SC174933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC728680Medicaid
2171357OtherPK
4218485OtherNCPDP