Provider Demographics
NPI:1902018088
Name:BINGLE ROAD PHARMACY
Entity Type:Organization
Organization Name:BINGLE ROAD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIKESHA
Authorized Official - Middle Name:MARSHEA
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-939-9230
Mailing Address - Street 1:6401 BINGLE RD
Mailing Address - Street 2:SUITE#107
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-1328
Mailing Address - Country:US
Mailing Address - Phone:713-939-9230
Mailing Address - Fax:713-939-9234
Practice Address - Street 1:6401 BINGLE RD
Practice Address - Street 2:SUITE#107
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-1328
Practice Address - Country:US
Practice Address - Phone:713-939-9230
Practice Address - Fax:713-939-9234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111417183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145777Medicaid