Provider Demographics
NPI:1437525268
Name:NIGER PHARMACY LLC
Entity Type:Organization
Organization Name:NIGER PHARMACY LLC
Other - Org Name:NIGER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-389-5624
Mailing Address - Street 1:25100 PITKIN RD STE 86A
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1978
Mailing Address - Country:US
Mailing Address - Phone:713-389-5624
Mailing Address - Fax:713-510-1627
Practice Address - Street 1:25100 PITKIN RD STE 86A
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77386-1978
Practice Address - Country:US
Practice Address - Phone:956-480-1652
Practice Address - Fax:713-510-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
TX301393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153210OtherPK
TX148058Medicaid