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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