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General NPI Number Information
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NPI Number | 1740500727
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Entity Type | Organization
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Legal Business Name | CENTRO PEDIATRIC PHARMACY LLC
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 7200 GLENVIEW DR STE 1
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City | RICHLAND HILLS
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State | TX
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Zip | 76180-7612
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Country | US
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Telephone | 817-369-8988
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Fax | 817-369-8991
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Provider Business Mailing Address
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Address Line | 7200 GLENVIEW DR STE 1
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City | RICHLAND HILLS
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State | TX
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Zip | 76180-7612
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Country | US
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Telephone | 817-537-2899
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Fax | 817-977-9099
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Authorized Official
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Title or Position | PIC
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Name | JACKSON DANG
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Credential |
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Telephone | 817-369-8988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26940
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License Number State | TX
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