Organization
FORT WORTH PHARMACY LLC
Active
Organization
FORT WORTH PHARMACY LLC
Active
Other names
FORT WORTH PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CREIGHTON MAYNARD BS (OWNER)
(817) 361-9960
Entity
Organization
Contact information
Practice address
7833 OAKMONT BLVD, SUITE 120, FORT WORTH, TX 76132-4231
(817) 361-9960
(817) 361-9970
Mailing address
7833 OAKMONT BLVD, SUITE 120, FORT WORTH, TX 76132-4231
(817) 361-9960
(817) 361-9970
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
30317
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2099205
PK
—
Enumeration date
08/18/2006
Last updated
09/17/2021
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