Pecan Prescription Shop LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

24387 Issued in TX

Legal business name

PECAN PRESCRIPTION SHOP LLC

Doing business as

Pecan Discount Drug

Practice address

9203 Plantation Dr Ste 1
Granbury, TX 76049-4222

Phone

(817) 573-9344

Fax

(817) 573-0953

NPI assigned

Jul 22, 2006

Last updated

Feb 6, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kristina Kay Gentry

Title

Manager

Phone

(817) 573-9344

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• PECAN DISCOUNT DRUG Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angela Adams, RPH

  • Pharmacist
  • Glen Rose, TX
  • NPI 1528291614
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738800000000",
    "number": "1285655241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9203 PLANTATION DR STE 1",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760494222",
            "telephone_number": "817-573-9344",
            "fax_number": "817-573-0953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9203 PLANTATION DR STE 1",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760494222",
            "telephone_number": "817-573-9344",
            "fax_number": "817-573-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECAN PRESCRIPTION SHOP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A",
        "authorized_official_last_name": "GENTRY",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "817-573-9344"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "24387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145664",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2098866",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PECAN DISCOUNT DRUG",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PECAN DISCOUNT DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul J. Goldman,MD Diagnostic Clinic
• Corey Patrick Pavelka, LCSW
• PCG Consulting, Inc.
• Pearl Dentures and Dental Care, PLLC
• Pecan Plantation Volunteer Fire Dept & Emergency Medical SVCS, Inc (Pecan Plantation EMS)
• Pecan Valley MHMR Region (Pecan Valley Centers for Behavioral and Developmental Healthcare)
• Pecan Valley MHMR Region
• Pecan Valley MHMR Region (Pecan Valley Centers for Behavioral and Developmental Healthcare)
• Pecan Valley MHMR Region
• Pecan Valley MHMR Region

• Community/Retail Pharmacy in Granbury, TX
• Providers in Granbury, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.