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General NPI Number Information
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NPI Number | 1043534795
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Entity Type | Organization
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Legal Business Name | PANCHO INDEPENDENT PHARMACY, INC
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 900 W ROSEDALE ST STE B
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City | FORT WORTH
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State | TX
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Zip | 76104-4537
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Country | US
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Telephone | 817-870-1900
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Fax | 817-870-1908
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Provider Business Mailing Address
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Address Line | 900 W ROSEDALE ST STE B
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City | FORT WORTH
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State | TX
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Zip | 76104-4537
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Country | US
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Telephone | 817-870-1900
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Fax | 817-870-1908
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Authorized Official
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Title or Position | MANAGER/PHARMACIST
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Name | DR. FRANCIS ETENGANI NJIE
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Credential | RPH
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Telephone | 713-253-5115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26859
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License Number State | TX
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