Organization
MINYARD FOOD STORES INC.
Active
Other names
Carnival Pharmacy #120
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL D. BYARS (PRESIDENT/CEO)
(972) 393-8700
Entity
Organization
Contact information
Practice address
102 NW 28TH ST, FT WORTH, TX 76106-7115
(817) 625-2462
(817) 624-4896
Mailing address
102 NW 28TH ST, FT WORTH, TX 76106-7115
(817) 625-2462
(817) 624-4896
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
18688
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4501171
NCPDP
TX
05
—
464222
—
TX
Enumeration date
11/01/2006
Last updated
11/16/2007
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