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General NPI Number Information
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NPI Number | 1609697457
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Entity Type | Organization
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Legal Business Name | EAST TEXAS HEMATOLOGY & ONCOLOGY
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1202 W FRANK AVE
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City | LUFKIN
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State | TX
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Zip | 75904-3304
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Country | US
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Telephone | 936-637-6415
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Fax | 346-226-3524
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Provider Business Mailing Address
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Address Line | 1202 W FRANK AVE
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City | LUFKIN
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State | TX
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Zip | 75904-3304
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Country | US
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Telephone | 936-637-6415
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Fax | 346-226-3524
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PRAMOD PINNAMANENI
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Credential | MD, MBA
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Telephone | 936-637-6415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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