Organization
CP
Active
Other names
Cardinal Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL PENNEY (OWNER)
(903) 983-3372
Entity
Organization
Contact information
Practice address
5309 FM 1252 W, KILGORE, TX 75662-1966
(903) 983-3372
(903) 983-3786
Mailing address
5309 FM 1252 W, KILGORE, TX 75662-1966
(903) 983-3372
(903) 983-3786
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
30542
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2159459
PK
—
05
—
VP1428487
—
TX
Enumeration date
10/26/2006
Last updated
06/16/2016
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