Provider Demographics
NPI:1447591417
Name:GOLDEN USA PHARMACY
Entity Type:Organization
Organization Name:GOLDEN USA PHARMACY
Other - Org Name:GOLDEN USA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:NWABUGWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-383-0626
Mailing Address - Street 1:4120 34TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2640
Mailing Address - Country:US
Mailing Address - Phone:915-383-0626
Mailing Address - Fax:806-368-9473
Practice Address - Street 1:4120 34TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2640
Practice Address - Country:US
Practice Address - Phone:806-368-9472
Practice Address - Fax:806-368-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX281753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5908186OtherNCPDP PROVIDER IDENTIFICATION NUMBER