Provider Demographics
NPI:1790796381
Name:BRIARGROVE PHARMACY INC
Entity Type:Organization
Organization Name:BRIARGROVE PHARMACY INC
Other - Org Name:BRIARGROVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-783-5704
Mailing Address - Street 1:6435 SAN FELIPE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2705
Mailing Address - Country:US
Mailing Address - Phone:713-783-5704
Mailing Address - Fax:713-783-5482
Practice Address - Street 1:6435 SAN FELIPE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2705
Practice Address - Country:US
Practice Address - Phone:713-783-5704
Practice Address - Fax:713-783-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX214593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4520599OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX145152Medicaid
4520599OtherNCPDP PROVIDER IDENTIFICATION NUMBER