Provider Demographics
NPI:1689065138
Name:BLACKSEA PHARMACEUTICALS INC
Entity Type:Organization
Organization Name:BLACKSEA PHARMACEUTICALS INC
Other - Org Name:MEDICX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AKWASI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMANKWAAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-594-6027
Mailing Address - Street 1:8433 FM 1464 RD STE S
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1103
Mailing Address - Country:US
Mailing Address - Phone:281-594-6027
Mailing Address - Fax:
Practice Address - Street 1:8433 FM 1464 RD STE S
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1103
Practice Address - Country:US
Practice Address - Phone:281-594-6027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297513336C0003X, 3336C0003X
333600000X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159709OtherPK
TX149516Medicaid