1033321146 NPI number — VALLEY BAPTIST PHARMACY SERVICES

Table of content: (NPI 1033321146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033321146 NPI number — VALLEY BAPTIST PHARMACY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY BAPTIST PHARMACY SERVICES
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:
CENTRAL MEDICAL PHARMACY
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:
1033321146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 PEASE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-389-1620
Provider Business Mailing Address Fax Number:
956-389-1026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
864 CENTRAL BLVD., STE. 1200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-544-0100
Provider Business Practice Location Address Fax Number:
956-544-0151
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EASTHAM
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT, COO
Authorized Official Telephone Number:
956-389-1620

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  25479 , 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: 4530057 . This is a "NCPDP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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