MEDICARE: DIVYARAJSINGH GOHIL

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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1588260632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIVYARAJSINGH GOHIL

Provider Business Mailing Address
First Line	:	2706 JACKSBORO HWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-1945
Country	:	US
Telephone Number	:	817-626-8255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 JACKSBORO HWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-1945
Country	:	US
Telephone Number	:	817-626-8255
Fax Number	:

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

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/04/2020

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Directions to “ DIVYARAJSINGH GOHIL ” Practice Location

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