Healthcare Provider Details

I. General information

NPI: 1851264865
Provider Name (Legal Business Name): NHI LA PHARMD, BCPPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 COOPER ST
FORT WORTH TX
76104-2710
US

IV. Provider business mailing address

1103 MERIWETHER ST
MANSFIELD TX
76063-6041
US

V. Phone/Fax

Practice location:
  • Phone: 682-303-0600
  • Fax:
Mailing address:
  • Phone: 817-564-1821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number45322
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: