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General NPI Number Information
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NPI Number | 1194523126
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Entity Type | Organization
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Legal Business Name | CANNERY PHARMACY SERVICES LLC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 75 MIRANDA LAMBERT WAY STE 19
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City | LINDALE
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State | TX
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Zip | 75771-3107
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Country | US
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Telephone | 430-235-1000
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Fax | 430-235-1000
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Provider Business Mailing Address
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Address Line | 75 MIRANDA LAMBERT WAY STE 19
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City | LINDALE
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State | TX
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Zip | 75771-3107
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Country | US
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Telephone | 430-235-1000
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Fax | 430-235-1000
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Authorized Official
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Title or Position | PHARMACIST
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Name | WILLIAM BESONG BESONG
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Credential |
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Telephone | 302-423-9052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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