Provider Demographics
NPI:1700873445
Name:BEST VALUE PHARMACIES INC
Entity Type:Organization
Organization Name:BEST VALUE PHARMACIES INC
Other - Org Name:BEST VALUE WEST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:817-295-6128
Mailing Address - Street 1:124 W RENFRO ST
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4260
Mailing Address - Country:US
Mailing Address - Phone:817-287-8125
Mailing Address - Fax:817-737-2722
Practice Address - Street 1:124 W RENFRO ST
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4260
Practice Address - Country:US
Practice Address - Phone:817-295-6128
Practice Address - Fax:817-295-5248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX152483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX470834Medicaid
2102811OtherPK
2102811OtherPK