Provider Demographics
NPI:1760959860
Name:PANCHO INDEPENDENT PHARMACY INC
Entity Type:Organization
Organization Name:PANCHO INDEPENDENT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NJIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHAR-D
Authorized Official - Phone:713-253-5115
Mailing Address - Street 1:1108 WISHING TREE LN
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5272
Mailing Address - Country:US
Mailing Address - Phone:713-253-5115
Mailing Address - Fax:
Practice Address - Street 1:790 KELLER PKWY STE 1505
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2403
Practice Address - Country:US
Practice Address - Phone:713-253-5115
Practice Address - Fax:817-379-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherDRUG MANUFACTURERS