Organization
PECAN PRESCRIPTION SHOP LLC
Active
Organization
PECAN PRESCRIPTION SHOP LLC
Active
Other names
PECAN DISCOUNT DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINA KAY GENTRY (MANAGER)
(817) 573-9344
Entity
Organization
Contact information
Practice address
9203 PLANTATION DR STE 1, GRANBURY, TX 76049-4222
(817) 573-9344
(817) 573-0953
Mailing address
9203 PLANTATION DR STE 1, GRANBURY, TX 76049-4222
(817) 573-9344
(817) 573-0953
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
24387
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145664
—
TX
01
—
2098866
PK
—
Enumeration date
07/22/2006
Last updated
02/06/2025
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