Organization
Q3BL PHARMACY LLC
Active
Other names
PAT WOOD DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
QUYNH PHAM (OWNER AND MANAGER)
(409) 985-8874
Entity
Organization
Contact information
Practice address
3648 GULFWAY DR, PORT ARTHUR, TX 77642-3674
(409) 985-8874
(409) 985-6568
Mailing address
PO BOX 3835, PORT ARTHUR, TX 77643-3835
(409) 985-8874
(409) 985-6568
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
23989
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
066691902
—
TX
05
—
066691903
—
TX
05
—
145523
—
TX
01
—
2090996
PK
—
Enumeration date
08/18/2006
Last updated
06/23/2016
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