Provider Demographics
NPI:1811031446
Name:C.B. PANNECK PHARMACIES, INC.
Entity Type:Organization
Organization Name:C.B. PANNECK PHARMACIES, INC.
Other - Org Name:DBA/ ST. FRANCIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST IN CHG
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:PANNECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-237-8215
Mailing Address - Street 1:210 COBEAN BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72437-9704
Mailing Address - Country:US
Mailing Address - Phone:870-237-8215
Mailing Address - Fax:870-237-8517
Practice Address - Street 1:210 COBEAN BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:LAKE CITY
Practice Address - State:AR
Practice Address - Zip Code:72437-9704
Practice Address - Country:US
Practice Address - Phone:870-237-8215
Practice Address - Fax:870-237-8517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR13221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187407407Medicaid
AR187407407Medicaid