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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