Provider Demographics
NPI:1962576538
Name:MXJ INC DBA BAGGETT PHARMACY
Entity type:Organization
Organization Name:MXJ INC DBA BAGGETT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:432-336-2297
Mailing Address - Street 1:509 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-5623
Mailing Address - Country:US
Mailing Address - Phone:432-336-2297
Mailing Address - Fax:432-336-6248
Practice Address - Street 1:509 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-5623
Practice Address - Country:US
Practice Address - Phone:432-336-2297
Practice Address - Fax:432-336-6248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4587171OtherNABDP #
TX091530802Medicaid
TX145104Medicaid