Provider Demographics
NPI:1699295089
Name:HGS PHARMACY LLC
Entity type:Organization
Organization Name:HGS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WINTANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRE-BERHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-372-3509
Mailing Address - Street 1:9434 PARKFIELD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6227
Mailing Address - Country:US
Mailing Address - Phone:512-593-3751
Mailing Address - Fax:512-249-7512
Practice Address - Street 1:9434 PARKFIELD DR STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6227
Practice Address - Country:US
Practice Address - Phone:512-593-3751
Practice Address - Fax:512-249-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX319613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177287OtherPK