Organization
IVMEDCO, INC
Active
Other names
IVMEDCO Fort Worth
Organization subpart
No
Provider details
NPI number
Authorized official
MANOHAR MIRYALA (OFFICER)
(817) 921-1957
Entity
Organization
Contact information
Practice address
3646 GRANBURY RD, STE 102, FORT WORTH, TX 76109-3717
(817) 336-4863
(817) 921-1957
Mailing address
3646 GRANBURY RD, STE 102, FORT WORTH, TX 76109-3717
(817) 336-4863
(817) 921-1957
Taxonomy
Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
Primary
13332
TX
Other
Enumeration date
10/26/2006
Last updated
06/14/2021
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