Healthcare Provider Details

I. General information

NPI: 1205164100
Provider Name (Legal Business Name): MR. AHMED SAMY FATI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9625 WHITE SETTLEMENT RD WALGREENS PHARMACY
FORT WORTH TX
76108-4406
US

IV. Provider business mailing address

9625 WHITE SETTLEMENT RD WALGREENS PHARMACY
FORT WORTH TX
76108-4406
US

V. Phone/Fax

Practice location:
  • Phone: 817-367-3469
  • Fax: 817-367-3560
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47417
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: