Fiesta Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

23914 Issued in TX

Legal business name

FIESTA PHARMACY

Doing business as

Buckner Village Pharmacy

Practice address

2947 S Buckner Blvd
Ste 500
Dallas, TX 75227-6952

Phone

(214) 275-8066

Fax

(214) 275-7796

NPI assigned

Sep 12, 2006

Last updated

Oct 20, 2015By 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

Elias Okonkwo, R.PH

Title

Owner

Phone

(214) 275-8066

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• BUCKNER VILLAGE PHARMACY Doing business as

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445299200000",
    "number": "1730283706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2947 S BUCKNER BLVD",
            "address_2": "SUITE #500",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752276952",
            "telephone_number": "214-275-8066",
            "fax_number": "214-275-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2947 S BUCKNER BLVD",
            "address_2": "STE 500",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752276952",
            "telephone_number": "214-275-8066",
            "fax_number": "214-275-7796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIESTA PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2015-10-20",
        "status": "A",
        "authorized_official_last_name": "OKONKWO",
        "authorized_official_first_name": "ELIAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-275-8066",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "23914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2099573",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145505",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BUCKNER VILLAGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Randolph B Fierro, M.D.
• Sandra Carolina Fierro, LPC
• Ruth S. Fierros Gonzalez, MA, LPC
• Stephanie Aracely Fierros, PA
• Fiesta Pharmacy
• Fiesta Pharmacy
• Mary Jessica Fiesta, ANP-BC
• Russell W Fife, DDS
• Susan Logreeta Fife, CNM
• Paul Figel, D.O.

• Community/Retail Pharmacy in Dallas, TX
• Providers in Dallas, 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 Oct 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.