Provider Demographics
NPI:1275725566
Name:BASILEIA GROUP INC
Entity Type:Organization
Organization Name:BASILEIA GROUP INC
Other - Org Name:THE PHARMACY EXPERIENCE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:713-263-7680
Mailing Address - Street 1:8118 FRY RD STE 1302
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7852
Mailing Address - Country:US
Mailing Address - Phone:713-263-7680
Mailing Address - Fax:713-263-7685
Practice Address - Street 1:8118 FRY RD STE 1302
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7852
Practice Address - Country:US
Practice Address - Phone:713-263-7680
Practice Address - Fax:713-263-7685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256843336C0003X
3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4545806OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX148375Medicaid