Provider Demographics
NPI:1285706861
Name:NELSON PRESCRIPTION PHARMACY INC
Entity type:Organization
Organization Name:NELSON PRESCRIPTION PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-637-3533
Mailing Address - Street 1:805 E TAHOKA RD
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79316-3635
Mailing Address - Country:US
Mailing Address - Phone:806-637-3533
Mailing Address - Fax:806-637-4212
Practice Address - Street 1:805 E TAHOKA ROAD
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316
Practice Address - Country:US
Practice Address - Phone:806-637-3533
Practice Address - Fax:806-637-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18343183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144649Medicaid
TXPH0522Medicaid
TX144649Medicaid