Provider Demographics
NPI:1710256045
Name:TEXAS VERVE ENTERPRISES
Entity Type:Organization
Organization Name:TEXAS VERVE ENTERPRISES
Other - Org Name:BLUE RIBBON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JADA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-935-3109
Mailing Address - Street 1:3517 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-4117
Mailing Address - Country:US
Mailing Address - Phone:281-838-8025
Mailing Address - Fax:281-838-8461
Practice Address - Street 1:3517 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-4117
Practice Address - Country:US
Practice Address - Phone:281-838-8025
Practice Address - Fax:281-838-8461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146523Medicaid
2133015OtherPK