=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104233030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMACY PREFERRED PHYSICIANS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2014
-----------------------------------------------------
Last Update Date | 07/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17300 DALLAS PKWY SUITE 1080A
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75248-1145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-335-7010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2806 CLEAR SPRINGS DR
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-7506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-822-6292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LANCE R COCHRAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-335-7010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------