Provider Demographics
NPI:1043352537
Name:PRINCETON PHARMACY INC.
Entity Type:Organization
Organization Name:PRINCETON PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:LYNSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-734-6281
Mailing Address - Street 1:PO BOX 1501
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-1501
Mailing Address - Country:US
Mailing Address - Phone:972-734-6281
Mailing Address - Fax:
Practice Address - Street 1:501 E. PRINCETON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407
Practice Address - Country:US
Practice Address - Phone:972-734-6281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145132Medicaid
4591649OtherNABP NUMBER
4591649OtherNABP NUMBER