Provider Demographics
NPI:1699435339
Name:AGGIELAND PHARMACY LLC
Entity type:Organization
Organization Name:AGGIELAND PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY THECHNICIAN
Authorized Official - Phone:979-803-0036
Mailing Address - Street 1:3601 E 29TH ST STE 14
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3815
Mailing Address - Country:US
Mailing Address - Phone:979-803-0036
Mailing Address - Fax:
Practice Address - Street 1:3601 E 29TH ST STE 14
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3815
Practice Address - Country:US
Practice Address - Phone:979-803-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy