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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