Provider Demographics
NPI:1447628607
Name:PANCHO INDEPENDENT PHARMACY INC
Entity type:Organization
Organization Name:PANCHO INDEPENDENT PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NJIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM-D
Authorized Official - Phone:972-279-1400
Mailing Address - Street 1:1108 WISHING TREE LN
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5272
Mailing Address - Country:US
Mailing Address - Phone:713-253-5115
Mailing Address - Fax:817-337-6081
Practice Address - Street 1:608 E BAILEY BOSWELL RD STE 140
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-3570
Practice Address - Country:US
Practice Address - Phone:713-253-5115
Practice Address - Fax:972-279-1415
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREEKWOOD PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-04
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy