Provider Demographics
NPI:1407373186
Name:Q3BL PHARMACY LLC
Entity Type:Organization
Organization Name:Q3BL PHARMACY LLC
Other - Org Name:PAT WOOD DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:QUYNH JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-985-8874
Mailing Address - Street 1:PO BOX 3835
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77643-3835
Mailing Address - Country:US
Mailing Address - Phone:409-985-8874
Mailing Address - Fax:409-985-6568
Practice Address - Street 1:3250 CENTRAL MALL DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8037
Practice Address - Country:US
Practice Address - Phone:409-853-1685
Practice Address - Fax:409-853-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5921817OtherNCPDP
TX31497OtherTEXAS STATE BOARD OF PHARMACY LICENSE
TX31497OtherTEXAS STATE BOARD OF PHARMACY LICENSE