Provider Demographics
NPI:1750396370
Name:PHARMWORKS, LLC
Entity type:Organization
Organization Name:PHARMWORKS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:V
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:281-232-3940
Mailing Address - Street 1:P.O. BOX 1047
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406
Mailing Address - Country:US
Mailing Address - Phone:956-581-2949
Mailing Address - Fax:956-461-2412
Practice Address - Street 1:1337 E. PALMA VISTA DR.
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-581-2949
Practice Address - Fax:956-461-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX242983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1538926Medicaid
4538926OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX1538926Medicaid