Provider Demographics
NPI:1013740026
Name:PBG INC
Entity type:Organization
Organization Name:PBG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:512-312-2111
Mailing Address - Street 1:203 RAILROAD ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-3437
Mailing Address - Country:US
Mailing Address - Phone:512-312-2111
Mailing Address - Fax:512-295-8300
Practice Address - Street 1:203 RAILROAD ST STE 2B
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3437
Practice Address - Country:US
Practice Address - Phone:512-312-2111
Practice Address - Fax:512-295-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy