Organization
I.D. DOCTORS PHARMACY
Active
Other names
I.D. Doctors Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
HEEWON SUH (PHARMACIST)
(972) 484-7700
Entity
Organization
Contact information
Practice address
2636 TIBBETS DR, BEDFORD, TX 76022-6919
(817) 858-0065
Mailing address
2636 TIBBETS DR, BEDFORD, TX 76022-6919
(972) 484-7700
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
21765
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146907401
—
TX
01
—
5908011
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/12/2013
Last updated
04/06/2022
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