Provider Demographics
NPI:1851928279
Name:PIONEER PHAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:PIONEER PHAMILY PHARMACY LLC
Other - Org Name:PIONEER PHAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-584-6657
Mailing Address - Street 1:1115 E PIONEER PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5853
Mailing Address - Country:US
Mailing Address - Phone:817-583-6998
Mailing Address - Fax:817-583-6998
Practice Address - Street 1:1115 E PIONEER PKWY STE 103
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5853
Practice Address - Country:US
Practice Address - Phone:817-583-6998
Practice Address - Fax:817-586-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy