Provider Demographics
NPI:1437379971
Name:PHARMACIA HENRIQUE
Entity type:Organization
Organization Name:PHARMACIA HENRIQUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:EKWA
Authorized Official - Last Name:NJIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-776-8469
Mailing Address - Street 1:2406 EMMETT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-5415
Mailing Address - Country:US
Mailing Address - Phone:469-776-8169
Mailing Address - Fax:833-357-1698
Practice Address - Street 1:2406 EMMETT ST STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-5415
Practice Address - Country:US
Practice Address - Phone:469-776-8169
Practice Address - Fax:833-357-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790842144Medicaid