Prodigious Industries LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

27978 Issued in TX

Legal business name

PRODIGIOUS INDUSTRIES LLC

Doing business as

Kearney Park Pharmacy

Practice address

3224 Gus Thomasson Rd
Mesquite, TX 75150-4004

Phone

(972) 329-1168

Fax

(972) 329-1436

NPI assigned

Apr 5, 2012

Organization subpart

No

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

Authorized official

Name

Fronce BarnesNPI 1265661284

Title

Pharmacist in Charge

Phone

(972) 329-1168

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Kearney Park Pharmacy 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.

• Fronce Barnes, PHARM.D

  • Pharmacist
  • Irving, TX
  • NPI 1265661284
  NPD Authorized official

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1477819266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3224 GUS THOMASSON RD",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751504004",
            "telephone_number": "972-329-1168",
            "fax_number": "972-329-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3224 GUS THOMASSON RD",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751504004",
            "telephone_number": "972-329-1168",
            "fax_number": "972-329-1436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGIOUS INDUSTRIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-05",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "FRONCE",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "972-329-1168"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "27978",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146566",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5905647",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kearney Park Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kearney Park Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacy in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.