Provider Demographics
NPI:1962040436
Name:QUEENSLAND ENTERPRISES INCORPORATED
Entity Type:Organization
Organization Name:QUEENSLAND ENTERPRISES INCORPORATED
Other - Org Name:BAY CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-762-7130
Mailing Address - Street 1:7909 W GRAND PKWY S STE 215
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8648
Mailing Address - Country:US
Mailing Address - Phone:281-762-7130
Mailing Address - Fax:713-804-5046
Practice Address - Street 1:7909 W GRAND PKWY S STE 215
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8648
Practice Address - Country:US
Practice Address - Phone:281-762-7130
Practice Address - Fax:713-804-5046
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEENSLAND ENTERPRISES INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150204Medicaid