Healthcare Provider Details

I. General information

NPI: 1306315536
Provider Name (Legal Business Name): PLOCKS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 TIBBETS DR STE C
BEDFORD TX
76022-6998
US

IV. Provider business mailing address

2600 TIBBETS DR STE C
BEDFORD TX
76022-6998
US

V. Phone/Fax

Practice location:
  • Phone: 817-785-7000
  • Fax:
Mailing address:
  • Phone: 817-785-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAVAID AJMAL
Title or Position: MANAGER
Credential:
Phone: 817-785-7000