Provider Demographics
NPI:1881284263
Name:PECAN PHARMACY LLC
Entity type:Organization
Organization Name:PECAN PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-227-9765
Mailing Address - Street 1:1850 LAKEPOINTE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6443
Mailing Address - Country:US
Mailing Address - Phone:214-227-9765
Mailing Address - Fax:214-227-9815
Practice Address - Street 1:1850 LAKEPOINTE DR STE 300
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-6443
Practice Address - Country:US
Practice Address - Phone:214-227-9765
Practice Address - Fax:214-227-9815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy