Provider Demographics
NPI:1992300701
Name:AN, PATRICK (RPH)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:AN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 KNIGHTSBRIDGE RD APT 4424
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-1353
Mailing Address - Country:US
Mailing Address - Phone:352-361-0319
Mailing Address - Fax:
Practice Address - Street 1:2222 N STORY RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-7064
Practice Address - Country:US
Practice Address - Phone:972-255-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist