Provider Demographics
NPI:1245857960
Name:BLUE CITY LLC
Entity type:Organization
Organization Name:BLUE CITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-262-1120
Mailing Address - Street 1:2646 S LOOP W STE 180A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5616
Mailing Address - Country:US
Mailing Address - Phone:832-582-5290
Mailing Address - Fax:
Practice Address - Street 1:2646 S LOOP W STE 180A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5616
Practice Address - Country:US
Practice Address - Phone:832-582-5290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy