Provider Demographics
NPI:1124430202
Name:POPHARMACY LLC
Entity type:Organization
Organization Name:POPHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-822-6292
Mailing Address - Street 1:2806 CLEAR SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7506
Mailing Address - Country:US
Mailing Address - Phone:972-822-6292
Mailing Address - Fax:
Practice Address - Street 1:17300 DALLAS PKWY
Practice Address - Street 2:SUITE 1080A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1145
Practice Address - Country:US
Practice Address - Phone:972-822-6292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid