Provider Demographics
NPI:1649750969
Name:BRAZOS HYBRID PHARMACY LLC
Entity Type:Organization
Organization Name:BRAZOS HYBRID PHARMACY LLC
Other - Org Name:BRAZOS HYBRID PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHUKS
Authorized Official - Middle Name:
Authorized Official - Last Name:NWANKWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-930-9301
Mailing Address - Street 1:9119 HWY 6 SUITE 230
Mailing Address - Street 2:PMB 382
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459
Mailing Address - Country:US
Mailing Address - Phone:832-930-9301
Mailing Address - Fax:281-232-7374
Practice Address - Street 1:545 FM 2977 ROAD SUITE 110
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469
Practice Address - Country:US
Practice Address - Phone:832-930-9301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
999999999OtherNONE