Provider Demographics
NPI:1336867225
Name:PRODIGIOUS INDUSTRIES LLC
Entity Type:Organization
Organization Name:PRODIGIOUS INDUSTRIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRONCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-740-7180
Mailing Address - Street 1:3224 GUS THOMASSON RD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4004
Mailing Address - Country:US
Mailing Address - Phone:972-329-1168
Mailing Address - Fax:972-329-1436
Practice Address - Street 1:3224 GUS THOMASSON RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4004
Practice Address - Country:US
Practice Address - Phone:972-329-1168
Practice Address - Fax:972-329-1436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy