Healthcare Provider Details

I. General information

NPI: 1275505307
Provider Name (Legal Business Name): DAVID E REDELSPERGER RPH, DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 7TH AVE
FORT WORTH TX
76104-2733
US

IV. Provider business mailing address

2909 L DON DODSON DR #1516
BEDFORD TX
76021-7941
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-4184
  • Fax:
Mailing address:
  • Phone: 817-283-4294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31135
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: