Provider Demographics
NPI:1174023493
Name:PRISTINERX CONSULTING LLC
Entity Type:Organization
Organization Name:PRISTINERX CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TSONGWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-400-8688
Mailing Address - Street 1:12046 GIDDINGS DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8874
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12046 GIDDINGS DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-8874
Practice Address - Country:US
Practice Address - Phone:214-400-8688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX499173336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy