Provider Demographics
NPI:1417050303
Name:BULLARD HOME INFUSION INC
Entity Type:Organization
Organization Name:BULLARD HOME INFUSION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-465-0214
Mailing Address - Street 1:1926 W MORTON
Mailing Address - Street 2:SUITE B
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-1617
Mailing Address - Country:US
Mailing Address - Phone:903-465-0214
Mailing Address - Fax:903-465-3492
Practice Address - Street 1:1926 W MORTON
Practice Address - Street 2:SUITE B
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1617
Practice Address - Country:US
Practice Address - Phone:903-465-0214
Practice Address - Fax:903-465-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156383336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0568130001Medicare ID - Type Unspecified