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General NPI Number Information
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NPI Number | 1083836613
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Entity Type | Organization
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Legal Business Name | FIESTA PHARMACY
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2947 S BUCKNER SUITE 500
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City | DALLAS
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State | TX
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Zip | 75227
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Country | US
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Telephone | 214-275-8066
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Fax | 214-275-7796
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Provider Business Mailing Address
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Address Line | 2947 S BUCKNER SUITE 500
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City | DALLAS
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State | TX
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Zip | 75227
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Country | US
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Telephone | 214-275-8066
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRINCE NWAORGU
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Credential |
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Telephone | 214-275-8066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 23914
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License Number State | TX
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