Provider Demographics
NPI:1376186643
Name:BOTW HEALTH, INC
Entity Type:Organization
Organization Name:BOTW HEALTH, INC
Other - Org Name:VALLEY VIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-320-3333
Mailing Address - Street 1:12895 JOSEY LN STE 124-263
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-8301
Mailing Address - Country:US
Mailing Address - Phone:972-982-2232
Mailing Address - Fax:972-982-2366
Practice Address - Street 1:12879 JOSEY LN STE 115
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-6374
Practice Address - Country:US
Practice Address - Phone:972-982-2232
Practice Address - Fax:972-982-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-19
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150166Medicaid