Organization
CRANDALL CITY MARKET INC
Active
Other names
City Market
Organization subpart
No
Provider details
NPI number
Authorized official
KURT JAEGER RPH (OWNER & PRESIDENT)
(817) 429-2571
Entity
Organization
Contact information
Practice address
3563 ALTON RD, FORT WORTH, TX 76109-2834
(817) 429-2571
(817) 921-6075
Mailing address
200 E RENFRO ST, BURLESON, TX 76028-3917
(817) 295-1051
(817) 295-2041
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
26418
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255566287
—
TX
01
—
4552281
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/20/2009
Last updated
12/10/2009
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