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Organization
FIESTA PHARMACY
Active
Organization
FIESTA PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRINCE C NWAORGU (PHARMACIST)
(214) 275-8066
Entity
Organization
Contact information
Practice address
6190 LYNDON B JOHNSON FWY, SUITE #600, DALLAS, TX 75240-6344
(972) 866-0017
(972) 866-0019
Mailing address
2947 S BUCKNER BLVD, SUITE #500, DALLAS, TX 75227-6944
(214) 275-8066
(214) 275-7796
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
23938
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145505
—
TX
Enumeration date
02/14/2007
Last updated
08/22/2020
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