Organization
SUPER FRISCO PHARMACY LLC
Active
Other names
CENTENNIAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JACK DEAR (OFFICER)
(214) 357-8889
Entity
Organization
Contact information
Practice address
5350 INDEPENDENCE PKWY STE 110A, FRISCO, TX 75035-4652
(469) 656-1431
(469) 675-3027
Mailing address
5350 INDEPENDENCE PKWY STE 110A, FRISCO, TX 75035-4652
(469) 656-1431
(469) 675-3027
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31520
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00
—
TX
05
—
000
—
TX
05
—
0000
—
TX
01
—
2170590
PK
—
Enumeration date
07/25/2017
Last updated
05/31/2018
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