Healthcare Provider Details

I. General information

NPI: 1740685890
Provider Name (Legal Business Name): PROSPER PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PRESTON RD N SUITE 10
PROSPER TX
75078-8779
US

IV. Provider business mailing address

1000 PRESTON RD N SUITE 10
PROSPER TX
75078-8779
US

V. Phone/Fax

Practice location:
  • Phone: 214-338-4010
  • Fax: 214-338-4011
Mailing address:
  • Phone: 214-338-4010
  • Fax: 214-338-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number29623
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ADI GELLI
Title or Position: CORPORATE MANAGER
Credential:
Phone: 214-338-4010