Provider Demographics
NPI:1174119267
Name:PECAN PHARMACY
Entity type:Organization
Organization Name:PECAN PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INDRAJITH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-539-6092
Mailing Address - Street 1:2885 DULLES AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2950
Mailing Address - Country:US
Mailing Address - Phone:832-539-6092
Mailing Address - Fax:832-539-6485
Practice Address - Street 1:2885 DULLES AVE
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2950
Practice Address - Country:US
Practice Address - Phone:832-539-6092
Practice Address - Fax:832-539-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy