Provider Demographics
NPI:1669236600
Name:PANNECK, CHRISTOPHER BRENT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BRENT
Last Name:PANNECK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MAGGIE CIR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-9521
Mailing Address - Country:US
Mailing Address - Phone:870-974-1502
Mailing Address - Fax:
Practice Address - Street 1:3710 N STATE LINE AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1934
Practice Address - Country:US
Practice Address - Phone:870-774-3146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist