Q3BL Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

23989 Issued in TX

Legal business name

Q3BL PHARMACY LLC

Doing business as

Pat Wood Drug Store

Practice address

3648 Gulfway Dr
Port Arthur, TX 77642-3674

Phone

(409) 985-8874

Fax

(409) 985-6568

NPI assigned

Aug 18, 2006

Last updated

Jun 23, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Quynh Pham

Title

Owner and Manager

Phone

(409) 985-8874

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• PAT WOOD DRUG STORE Doing business as

Tax ID family

Pat Wood Drug Store2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Q3BL Pharmacy LLC

  dba Pat Wood Drug Store

  • Community/Retail Pharmacy
  • Port Arthur, TX
  • NPI 1407373186
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brandon Pham, PHARM D.

  • Pharmacist
  • Port Arthur, TX
  • NPI 1225704992
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466640000000",
    "number": "1467566455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3835",
            "city": "PORT ARTHUR",
            "state": "TX",
            "postal_code": "776433835",
            "telephone_number": "409-985-8874",
            "fax_number": "409-985-6568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3648 GULFWAY DR",
            "city": "PORT ARTHUR",
            "state": "TX",
            "postal_code": "776423674",
            "telephone_number": "409-985-8874",
            "fax_number": "409-985-6568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "Q3BL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2016-06-23",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "QUYNH",
        "authorized_official_title_or_position": "OWNER AND MANAGER",
        "authorized_official_telephone_number": "409-985-8874"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "23989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145523",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2090996",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "066691902",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "066691903",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PAT WOOD DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Port Arthur, TX
• Providers in Port Arthur, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; 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.