Provider Demographics
NPI:1730161738
Name:BGS PHARMACY PARTNERS INC
Entity type:Organization
Organization Name:BGS PHARMACY PARTNERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-328-6421
Mailing Address - Street 1:3500 WILLIAM D TATE AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8749
Mailing Address - Country:US
Mailing Address - Phone:817-251-8073
Mailing Address - Fax:817-552-1224
Practice Address - Street 1:3500 WILLIAM D TATE AVE STE 200
Practice Address - Street 2:STE 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8734
Practice Address - Country:US
Practice Address - Phone:817-251-8073
Practice Address - Fax:817-552-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243033336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146101Medicaid
4539409OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX350231Medicaid