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General NPI Number Information
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NPI Number | 1447628607
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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 | 09/04/2015
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 608 E BAILEY BOSWELL RD STE 140
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City | FORT WORTH
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State | TX
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Zip | 76131-3570
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Country | US
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Telephone | 713-253-5115
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Fax | 972-279-1415
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Provider Business Mailing Address
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Address Line | 1108 WISHING TREE LN
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City | KELLER
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State | TX
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Zip | 76248-5272
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Country | US
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Telephone | 713-253-5115
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Fax | 817-337-6081
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Authorized Official
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Title or Position | PIC
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Name | DR. FRANCIS NJIE
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Credential | PHARM-D
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Telephone | 972-279-1400
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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 | 30349
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License Number State | TX
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