=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407475684
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PCN CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2020
-----------------------------------------------------
Last Update Date | 07/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3201 W SANER AVE STE 100
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75233-1430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-377-4310
-----------------------------------------------------
Fax | 214-331-7630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3108 WILLOW BROOK DR
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-2075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-367-9018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/OWNER
-----------------------------------------------------
Name | DAVID DUC NGUYEN
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 469-206-6116
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------