Provider Demographics
NPI:1013664614
Name:BG&M PHARMACY, LLC
Entity Type:Organization
Organization Name:BG&M PHARMACY, LLC
Other - Org Name:FOREST PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:JEWEL
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:682-250-3116
Mailing Address - Street 1:2410 FOREST PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1702
Mailing Address - Country:US
Mailing Address - Phone:682-250-3116
Mailing Address - Fax:
Practice Address - Street 1:2410 FOREST PARK BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1702
Practice Address - Country:US
Practice Address - Phone:682-250-3116
Practice Address - Fax:817-549-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy