MEDICARE: KOHLER HOMECARE PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	19367	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2104142	OTHER		PK
4	815747831	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1053322545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOHLER HOMECARE PHARMACY, INC.

Provider Business Mailing Address
First Line	:	2204 PARK SPRINGS BLVD
Second Line	:	SUITE A
City	:	ARLINGTON
State	:	TX
Zip	:	76013-5642
Country	:	US
Telephone Number	:	817-861-4631
Fax Number	:	620-508-2755

Provider Business Practice Location Address
First Line	:	2204 PARK SPRINGS BLVD
Second Line	:	SUITE A
City	:	ARLINGTON
State	:	TX
Zip	:	76013-5642
Country	:	US
Telephone Number	:	817-861-4631
Fax Number	:	620-508-2755

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAULETTE SALVANT
Credential	:	RPH
Telephone Number	:	817-861-4631

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	08/06/2019

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Directions to “KOHLER HOMECARE PHARMACY, INC. ” Practice Location

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