Provider Demographics
NPI:1790842144
Name:PHARMACIA HENRIQUE
Entity Type:Organization
Organization Name:PHARMACIA HENRIQUE
Other - Org Name:PHARMACIA HENRIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NJIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:214-587-6922
Mailing Address - Street 1:1430 N MACARTHUR BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-4480
Mailing Address - Country:US
Mailing Address - Phone:214-587-6922
Mailing Address - Fax:888-502-0861
Practice Address - Street 1:1430 N MACARTHUR BLVD STE 107
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4480
Practice Address - Country:US
Practice Address - Phone:214-587-6922
Practice Address - Fax:888-502-0861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX243243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4539170OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX145598Medicaid