Individual
DETTY PALLIKKUNEAL JOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4760 STATE HIGHWAY 121, LEWISVILLE, TX 75056-2913
(469) 287-0346
Mailing address
4760 STATE HIGHWAY 121, LEWISVILLE, TX 75056-2913
(469) 287-0346
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
53673
TX
Other
Enumeration date
08/14/2013
Last updated
08/14/2013
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