# I.D. DOCTORS PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** I.D. Doctors Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245579143
- **Authorized official:** HEEWON SUH (PHARMACIST)
- **Authorized official phone:** (972) 484-7700

## Contact information

- **Practice address:** 2636 TIBBETS DR, BEDFORD, TX 76022-6919
- **Practice address phone:** (817) 858-0065
- **Mailing address:** 2636 TIBBETS DR, BEDFORD, TX 76022-6919
- **Mailing address phone:** (972) 484-7700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | 21765 | TX | Yes |

## Other

- **Enumeration date:** 02/12/2013
- **Last updated:** 04/06/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 146907401 | — | TX |
| 01 | — | 5908011 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |