Provider Demographics
NPI:1770132607
Name:NEXGEN PHARMACEUTICALS LLC
Entity type:Organization
Organization Name:NEXGEN PHARMACEUTICALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-678-8143
Mailing Address - Street 1:2005 FORT WORTH HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4780
Mailing Address - Country:US
Mailing Address - Phone:817-599-7781
Mailing Address - Fax:
Practice Address - Street 1:2005 FORT WORTH HWY STE 100
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4780
Practice Address - Country:US
Practice Address - Phone:817-599-7781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy