MEDICARE: REGINA LYNNE ALFORD RPH

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	183500000X	Pharmacist	35055	TX

General Provider Information

NPI Number	:	1164718326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA LYNNE ALFORD RPH

Provider Business Mailing Address
First Line	:	6604 LAKE WORTH BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3000
Country	:	US
Telephone Number	:	817-302-0084
Fax Number	:

Provider Business Practice Location Address
First Line	:	6604 LAKE WORTH BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3000
Country	:	US
Telephone Number	:	817-302-0084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	06/24/2011

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