Provider Demographics
NPI:1750954103
Name:BANCROFT STREET 2 LLC
Entity type:Organization
Organization Name:BANCROFT STREET 2 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDULHAMID
Authorized Official - Middle Name:SALEH
Authorized Official - Last Name:NASSOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-522-0605
Mailing Address - Street 1:791 FM 1103 STE 121
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3673
Mailing Address - Country:US
Mailing Address - Phone:210-236-7700
Mailing Address - Fax:
Practice Address - Street 1:791 FM 1103 STE 121
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3673
Practice Address - Country:US
Practice Address - Phone:313-522-0605
Practice Address - Fax:210-310-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy