MEDICARE: ALLIANCE PHARMACY LLC

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	3336C0003X	Community/Retail Pharmacy	32160	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32160	OTHER	TX	TEXAS BOARD OF PHARMACY

General Provider Information

NPI Number	:	1588140131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE PHARMACY LLC

Provider Business Mailing Address
First Line	:	9601 N BEACH ST STE 105
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6432
Country	:	US
Telephone Number	:	409-293-9399
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 N BEACH ST STE 105
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6432
Country	:	US
Telephone Number	:	409-293-9399
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JESSEY NGUYEN
Credential	:
Telephone Number	:	817-952-1999

Provider Enumeration Date	:	07/17/2018
Last Update Date	:	09/12/2019

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Directions to “ALLIANCE PHARMACY LLC ” Practice Location

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