Organization
Q3BL PHARMACY LLC
Active
Other names
Pat Wood Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
MR. QUYNH JEFF PHAM (OWNER/MGR)
(409) 985-8874
Entity
Organization
Contact information
Practice address
3250 CENTRAL MALL DR, PORT ARTHUR, TX 77642-8037
(409) 853-1685
(409) 853-1713
Mailing address
PO BOX 3835, PORT ARTHUR, TX 77643-3835
(409) 985-8874
(409) 985-6568
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
31497
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31497
TEXAS STATE BOARD OF PHARMACY LICENSE
TX
01
—
5921817
NCPDP
TX
Enumeration date
08/24/2017
Last updated
03/07/2023
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