1730161738 NPI number — BGS PHARMACY PARTNERS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730161738 NPI number — BGS PHARMACY PARTNERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BGS PHARMACY PARTNERS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPECTRUM PHARMACY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730161738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 WILLIAM D TATE AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76051-8749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-251-8073
Provider Business Mailing Address Fax Number:
817-552-1224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 WILLIAM D TATE AVE STE 200
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
GRAPEVINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76051-8734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-251-8073
Provider Business Practice Location Address Fax Number:
817-552-1224
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LANHAM
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
817-328-6421

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  24303 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 146101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4539409 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 350231 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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