Provider Demographics
NPI:1285024992
Name:PIONEER PHARMACEUTICALS LLC
Entity Type:Organization
Organization Name:PIONEER PHARMACEUTICALS LLC
Other - Org Name:PIONEER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-759-5114
Mailing Address - Street 1:5101 AVENUE H STE 18
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2024
Mailing Address - Country:US
Mailing Address - Phone:832-759-5114
Mailing Address - Fax:832-779-8434
Practice Address - Street 1:5101 AVENUE H STE 18
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2024
Practice Address - Country:US
Practice Address - Phone:832-759-5114
Practice Address - Fax:832-779-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX297393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149149Medicaid
2155829OtherPK
TX149149Medicaid