Provider Demographics
NPI:1952849309
Name:OBEN PHARMACY GROUP LLC
Entity Type:Organization
Organization Name:OBEN PHARMACY GROUP LLC
Other - Org Name:GOLDSTAR LONG TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BESSEM
Authorized Official - Middle Name:
Authorized Official - Last Name:OBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-235-0807
Mailing Address - Street 1:4500 CARTER CREEK PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4494
Mailing Address - Country:US
Mailing Address - Phone:844-465-3582
Mailing Address - Fax:855-201-8501
Practice Address - Street 1:4500 CARTER CREEK PKWY STE 202
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4494
Practice Address - Country:US
Practice Address - Phone:844-465-3582
Practice Address - Fax:855-201-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX315903336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2172246OtherPK