Provider Demographics
NPI:1578011912
Name:BORGER PHARMACY LLC
Entity Type:Organization
Organization Name:BORGER PHARMACY LLC
Other - Org Name:BORGER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:806-274-9635
Mailing Address - Street 1:524 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-2802
Mailing Address - Country:US
Mailing Address - Phone:806-274-9635
Mailing Address - Fax:806-274-9669
Practice Address - Street 1:524 W 10TH ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-2802
Practice Address - Country:US
Practice Address - Phone:806-274-9635
Practice Address - Fax:806-274-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
TX311253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149563Medicaid
2164475OtherPK