Provider Demographics
NPI:1679889992
Name:BANP ENTERPRISES LLC
Entity Type:Organization
Organization Name:BANP ENTERPRISES LLC
Other - Org Name:FAMILY PHARNACY OF POTTSBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PEIPPO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-786-2006
Mailing Address - Street 1:563 W FM 120
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-9039
Mailing Address - Country:US
Mailing Address - Phone:903-786-2006
Mailing Address - Fax:903-786-4542
Practice Address - Street 1:563 W FM 120
Practice Address - Street 2:
Practice Address - City:POTTSBORO
Practice Address - State:TX
Practice Address - Zip Code:75076-9039
Practice Address - Country:US
Practice Address - Phone:903-786-2006
Practice Address - Fax:903-786-4542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX313023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148327Medicaid
2126449OtherPK