Provider Demographics
NPI:1639205495
Name:NBJ PHARMACY
Entity Type:Organization
Organization Name:NBJ PHARMACY
Other - Org Name:NBJ PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HYACINTHE
Authorized Official - Middle Name:
Authorized Official - Last Name:NDRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-222-9450
Mailing Address - Street 1:7830 W GRAND PKWY S STE 160
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5817
Mailing Address - Country:US
Mailing Address - Phone:832-222-9450
Mailing Address - Fax:832-222-9477
Practice Address - Street 1:7830 W GRAND PKWY S STE 160
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5817
Practice Address - Country:US
Practice Address - Phone:832-222-9450
Practice Address - Fax:832-222-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243093336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145583Medicaid
2098696OtherPK