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Organization
PRODIGIOUS INDUSTRIES LLC
Active
Organization
PRODIGIOUS INDUSTRIES LLC
Active
Other names
Kearney Park Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
FRONCE BARNES (PHARMACIST IN CHARGE)
(972) 329-1168
Entity
Organization
Contact information
Practice address
3224 GUS THOMASSON RD, MESQUITE, TX 75150-4004
(972) 329-1168
(972) 329-1436
Mailing address
3224 GUS THOMASSON RD, MESQUITE, TX 75150-4004
(972) 329-1168
(972) 329-1436
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
27978
TX
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146566
—
TX
01
—
5905647
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/05/2012
Last updated
08/22/2022
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