Bear Creek Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

27405 Issued in TX

Legal business name

BEAR CREEK PHARMACY LLC

Practice address

101 Bear Creek Pkwy Ste B
Keller, TX 76248-2531

Phone

(817) 562-4766

Fax

(817) 562-4871

NPI assigned

Jan 20, 2011

Organization subpart

No

Name

Henry Simo

Title

Owner/Pic

Phone

(817) 562-4766

• BEAR CREEK PHARMACY LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 3, 2019.

{
    "created_epoch": "1295481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570060800000",
    "number": "1104121235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BEAR CREEK PKWY STE B",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762482531",
            "telephone_number": "817-562-4766",
            "fax_number": "817-562-4871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BEAR CREEK PKWY STE B",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762482531",
            "telephone_number": "817-562-4766",
            "fax_number": "817-562-4871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAR CREEK PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-20",
        "last_updated": "2019-10-03",
        "status": "A",
        "authorized_official_last_name": "SIMO",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "OWNER/PIC",
        "authorized_official_telephone_number": "817-562-4766"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "27405",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2129429",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BEAR CREEK PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BEAR CREEK PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vijaya Lakshmi Bathina, DMD
• Malina Lynn Bauer, RDH
• Jessfor G Baugh, DMD
• Julie Baughman
• Baylor Regional Medical Center at Grapevine
• Bear Creek Surgery Center, LLC
• Vickie Annette Beavers, LPC, LMFT
• Erica Michelle Bedford, M.S CCC/SLP
• Scott Bedichek, DDS, MS
• Lauren Beene

• All providers in Keller, TX
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.