Organization
FIESTA PHARMACY
Active
Other names
BUCKNER VILLAGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ELIAS OKONKWO R.PH (OWNER)
(214) 275-8066
Entity
Organization
Contact information
Practice address
2947 S BUCKNER BLVD, STE 500, DALLAS, TX 75227-6952
(214) 275-8066
(214) 275-7796
Mailing address
2947 S BUCKNER BLVD, SUITE #500, DALLAS, TX 75227-6952
(214) 275-8066
(214) 275-7796
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
23914
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145505
—
TX
01
—
2099573
PK
—
Enumeration date
09/12/2006
Last updated
10/20/2015
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