Provider Demographics
NPI:1386186641
Name:BGA PHARMACIES, LLC
Entity type:Organization
Organization Name:BGA PHARMACIES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO (MANAGING OFFICER, AUTHORIZED S
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-271-8305
Mailing Address - Street 1:1620 W. NORTHWEST HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-572-0009
Mailing Address - Fax:817-572-0221
Practice Address - Street 1:1 INDEPENDENCE PLAZA
Practice Address - Street 2:SUITE 900A
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-259-5460
Practice Address - Fax:205-259-5463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BGA PHARMACIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-17
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
AL1146713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166248OtherPK
AL196661Medicaid