Provider Demographics
NPI:1174400956
Name:WILLOWBEND PHARMA SELECT LLC
Entity type:Organization
Organization Name:WILLOWBEND PHARMA SELECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-667-1071
Mailing Address - Street 1:3610 WILLOWBEND BLVD STE 1020
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1113
Mailing Address - Country:US
Mailing Address - Phone:832-628-3260
Mailing Address - Fax:
Practice Address - Street 1:3610 WILLOWBEND BLVD STE 1020
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1113
Practice Address - Country:US
Practice Address - Phone:832-628-3260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy