MEDICARE: MISSION TRAVIS MERCY

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	3336C0002X	Clinic Pharmacy

General Provider Information

NPI Number	:	1679436703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION TRAVIS MERCY

Provider Business Mailing Address
First Line	:	PO BOX 11557
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-0557
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	775 WEST BOWIE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110
Country	:	US
Telephone Number	:	817-840-3501
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	CELESTE COKER
Credential	:	PHARM.D.
Telephone Number	:	817-840-3501

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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Directions to “MISSION TRAVIS MERCY ” Practice Location

Language	Start Address	Practice Location

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